Our consultants have worked with a US-based medical device company, CSA Medical, to innovate a 30-minute procedure to treat patients with chronic obstructive pulmonary disease (COPD), with chronic bronchitis. Chronic bronchitis is a progressive lung disease associated with a chronic cough and mucous productivity.

The new minimally invasive procedure, called RejuvenAir® metered cryospray, delivers liquid nitrogen to the affected airways through a flexible camera passed through the mouth. The liquid nitrogen sprays freeze and destroy the diseased cells, reducing inflammation and providing a foundation for new, healthy cells to repopulate and make it easier to breathe. While existing medications help to manage symptoms, our new procedure treats the cause of the disease, allowing for an improved quality of life.

The misconceptions around COPD

Around 1.4 million people in the UK have COPD, an umbrella term which describes a range of lung conditions, including chronic bronchitis. Chronic bronchitis affects the lining of the lungs, resulting in a build-up of debris and mucous which can be difficult to clear, therefore making it harder to breathe.

9 out of 10 COPD cases are caused by cigarette smoking, with air pollution, dust and genetics contributing to the remaining cases. With symptoms including breathlessness, a persistent cough and phlegm production, COPD with chronic bronchitis is often misinterpreted as simply a “smoker’s cough”.

As these symptoms often do not appear until a person is in their 40s or 50s, COPD and chronic bronchitis are often underdiagnosed. In fact, it is thought that up to 50% of people with COPD are not aware they have the condition.

“A lot of patients think they have asthma in later life because the symptoms are similar, but really they have a form of COPD,” explains Professor Pallav Shah, consultant respiratory physician at Royal Brompton Hospital.

One of the first diagnostic tests for COPD with chronic bronchitis should be spirometry: a simple test to measure how much air you can inhale and exhale. This test helps our consultants determine whether a patient has airflow limitation, which is the main indicator of COPD.

Minimally invasive treatment for chronic bronchitis

Lining the lungs are tiny hair-like structures called cilia, which help to clear debris and mucous from the airways. Scattered throughout the cilia are goblet cells, which produce mucous to help protect the lining of the lung. In chronic bronchitis, the cilia become damaged and cannot sufficiently clear the mucous produced by the goblet cells. As a result, the goblet cells overproduce mucous and the airways become narrowed and inflamed, causing breathing difficulties.

Well-established therapies for later stage COPD include oxygen therapy (receiving oxygen through a mask), lung volume reduction (a surgical procedure to remove damaged parts of the lung) and even a lung transplant.

“RejuvenAir® metered cryospray treatment offers a new minimally invasive approach to treating COPD with chronic bronchitis, and it treats the underlying cause of the disease, rather than just managing symptoms,” explains Dr Christopher Orton, consultant in respiratory medicine.

The treatment is performed orally via a bronchoscope (a thin, lighted, flexible tube which is used to look at the lungs and airways). During the procedure, metered doses of extremely cold (-196C) liquid nitrogen are delivered to the airways. The liquid nitrogen freezes and kills the diseased cells in the lungs but keeps the cell structure intact, allowing new, healthy cells to form and improve breathing capabilities in the long term.

The two-step procedure is performed under general anaesthetic and, as each step can be performed within half an hour, the patient is usually able to return home within a few hours.

“Each lung is treated during a separate procedure, usually six weeks apart,” explains Professor Shah. “We are the only ones internationally who can provide this treatment,” he adds.

The RejuvenAir® cryospray treatment removes the damaged cilia to encourage regeneration of healthy cells

Pre-determined measurements for precise dosage

“Using metered cryospray technology, pre-determined doses (based on patient anatomy) of liquid nitrogen are delivered systematically through the airways,” says Professor Shah.

The RejuvenAir® System is designed with safety cut-off technology, which stops the flow of nitrogen once it reaches the required temperature. “The liquid nitrogen delivery is super controlled, as it anticipates the volume of medication to be delivered. If the treatment area gets colder quicker than anticipated, the system shuts off the delivery,” explains Dr Orton.

“Patients usually experience improved symptoms two or three days after the procedure,” says Professor Shah. Based on the clinical trials of the procedure, patients also reported a significant improvement in quality of life at one year post treatment, indicating the efficacy of the metered cryospray in treating chronic bronchitis in the long term.

Who is the treatment for?

The RejuvenAir® treatment is suitable for most people with chronic bronchitis, although it is not suitable for pregnant or nursing women, patients with compromised lung tissue or patients who have received previous lung surgery.

For more information or to book an appointment, please contact our customer care team.