Bronchoscopic Thermal Saline Ablation (BTSA) of Emphysematous Lung. A New Emphysema Therapy

Shamir Medical Center (Assaf-Harofeh)

Status and phase: Unknown; Phase 2; Phase 1

Conditions: Emphysema

Treatments: Procedure: Endoscopic lung volume reduction

Study type: Interventional

Funder types: Other

Identifiers

NCT01920321

195/12

Details and patient eligibility

About

Aim: To evaluate feasibility, safety and efficacy of relatively simple approach of bronchoscopic lung volume reduction (LVR) technology, independent of collateral ventilation.

Description: Patients with severe upper lobes heterogeneous emphysema, undergo unilateral bronchoscopic installation of saline thermal energy 50-55 ºC intending to induce an inflammatory airway and parenchymal injury and consequently fibrotic response resulting in LVR;

Full description

Inclusion criteria:

1. Age 40-75 unlimited sex. 20 subjects
2. chronic obstructive pulmonary disease (COPD), GOLD 3-4 (global obstructive lung disease).
3. CT scan of lung and included high resolution slices. Demonstrating emphysematous, bullotic changes in the upper lobes.
4. Pulmonary function tests results- total lung capacity(TLC)>110%, residual volume(RV)>150%, diffusion of lung CO(DLCO)<80%,forced expiratory volume 1 second(FEV1):15-45%.
5. 6 minute walking distance (6MWD)> 140 meters.

Exclusion criteria:

1. Active ischemic heart disease, significant arrhythmia. ejection fraction (EF) <40%.
2. COPD that cause carbon bioxide(CO2) retention above 50 mm Hg and / or oxygen saturation at rest below 88%.
3. Pulmonary hypertension> 45 mmHg, according to the Echo Test.
4. . Cancer treatment with chemotherapy / radiation or expected life expectancy of less than two years.5. Pregnancy.

Methods: . A. Patient preparation and sedation as in diagnostic bronchoscopy. Sedation will be based on midzoln + demerol. The patients will be treated prior the treatment with Inhalation with salbutamol ans ipratropium bromide. Flexible bronchoscope with outer diameter 5 mm is introduced to the targated upper lobe, and placed in wedged position. This is followed by installion of 0.9% natriu, chloride(NaCl) at a temperature of 55ºC exit temperature 50ºC) in portions of 40 ml to 200 ml (in bronchoalveolar lavage up to 300 ml is acceptable. The patient is placed in horizontal position, and continuous ECG blood pressure. Oxygen saturation are monitored. This monitoring will be continue at least 2 hours after treatment. A chest x-ray is followed and the patient remain in the department for overnight.

Tracking: Minimum of 6 months - Outpatient follow up include in addition to physical examination extended pulmonary function test and after 3-6 months. low radiation chest CT.

Enrollment: 20 estimated patients

Sex: All

Ages: 40 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age 40-75 unlimited sex. 20 subjects

2. COPD, GOLD 3-4 (global obstructive lung disease).

3. CT scan of lung and included high resolution slices. Demonstrating emphysematous, bullotic changes in the upper lobes.

4. Pulmonary function tests results- TLC> 110%, RV> 150%, DLCO <80%,FEV1: 15-45%.

5. 6 minute walking distance > 140 meters.

Exclusion criteria

1. Active ischemic heart disease, significant arrhythmia. Ejection fraction (EF) <40%.
2. Chronic lung disease that cause CO2 retention above 50 mm Hg and / or oxygen saturation at rest below 88%.
3. Pulmonary hypertension> 45 mmHg, according to the Echo Test.
4. . Cancer treatment with chemotherapy / radiation or expected life expectancy of less than two years.
5. Pregnancy -

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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20 participants in 1 patient group

Endoscopic lung volume reduction

Experimental group

Description:

After usual sedation, bronchoscope is introduce to the lung and palced in segmental wedge position then hot salineis instilled. Same procedure to others affected segments.

Treatment:

Procedure: Endoscopic lung volume reduction