Our consultants have worked with device company, CSA Medical, to develop an innovative way to treat chronic obstructive pulmonary disease (COPD) with chronic bronchitis. The minimally invasive bronchoscopy procedure, called RejuvenAir® metered cryospray, delivers medical-grade liquid nitrogen to the affected parts of the airways to freeze and destroy the diseased cells. Rather than managing symptoms, the 30-minute procedure treats the cause of the disease, allowing for new, healthy and normal functioning cells to repopulate the lung lining.

The underrepresentation of COPD

Around 1.4 million people in the UK have COPD; a term which describes a range of lung conditions affecting the alveoli and bronchi. 9 out of 10 COPD cases are caused by cigarette smoking, with air pollution, dust and genetics contributing to the remaining case load.

With symptoms including breathlessness, a persistent cough and sputum, patients frequently misinterpret COPD with chronic bronchitis as simply a “smoker’s cough”. Professor Pallav Shah, consultant respiratory physician at Royal Brompton Hospital and lead for the service, explains: “Symptoms often do not appear until patients are in their 40s or 50s, leading to underdiagnosis of COPD and chronic bronchitis.” In fact, it is thought that up to 50% of people with COPD are undiagnosed.

One of the first diagnostic tests for COPD with chronic bronchitis should be spirometry, to help determine whether patients have airflow limitations, which is the crux of COPD. “A lot of patients think they have asthma in later life, but really it is COPD,” explains Dr Christopher Orton, consultant in respiratory medicine at Royal Brompton Hospital.

30-minute treatment for COPD

Chronic bronchitis can damage the cilia in the lungs (which help to clear debris and mucous secreted by goblet cells). As a result, the goblet cells overproduce mucous, which the cilia cannot sufficiently clear. This build-up of mucous causes breathing difficulties for the patient as the airways become inflamed.

Well-established treatments for advanced COPD include oxygen therapy, lung volume reduction and even a lung transplant. The RejuvenAir® procedure offers an outpatient bronchoscopic approach for chronic bronchitis, without the risks of an invasive surgery.

Relying on cryotherapy (freezing therapy), the RejuvenAir® System procedure delivers metered doses of liquid nitrogen to the airways at minus 196 degrees to target the source of the cough and mucous production.

“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 two-step RejuvenAir® 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.

RejuvenAir® metered cryospray treatment removes the damaged airway epithelium, to encourage regeneration of healthy cells

Cryotherapy to preserve healthy cells

The liquid nitrogen freezes the diseased cells before they have time to dehydrate. This means we can destroy the contents of the cell but keep the extracellular matrix in place to allow repopulation to occur. “This way, it causes no scarring, which is the principle difference between cryotherapy and thermal treatments,” adds Dr Orton.

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

“RejuvenAir® metered cryospray treatment offers a new approach for patients with chronic bronchitis. It is a minimally invasive approach, which treats the underlying cause of the disease,” explains Dr Orton.

Leading the way for chronic bronchitis treatment

Based on the clinical trials of the procedure, a clinically significant change in St George’s Respiratory Questionnaire was observed between arms, at six months post treatment (-9.6 points; p=0.02), compared to baseline. The patient-reported outcomes indicate that metered cryospray effectively contributes to an improved quality of life in patients with chronic bronchitis.

“Previously there has been no cure for chronic bronchitis but this new procedure aims to treat the underlying cause, rather than just temporarily relieve symptoms,” says Professor Shah. “After the treatment, patients usually experience improved symptoms after two or three days, with an improved sense of wellbeing as a result,” he adds.

When to refer to us

Any patient with chronic bronchitis (chronic cough and sputum productivity), or symptoms of chronic bronchitis, can be referred to us. However, the patient must be suitable for general anaesthetic.