Targeted Lung Denervation: Promising New Treatment for COPD

Recent research shows promising results for a new "minimally-invasive" procedure called targeted lung denervation. This procedure potentially offers a safe alternative to more traditional COPD treatment modalities.

What is targeted lung denervation?

This therapy, called TLD for short, requires a health care professional to pass a special type of tube through a device called a bronchoscope into the lungs. A bronchoscope is a flexible tube made of fiber optic material, with a light and a small camera. A doctor threads the tube through your nose or mouth and then down your throat and on to the bronchi and bronchioles of your lungs. A bronchoscopy allows the doctor to look into your lungs.

The TLD catheter emits a type of electrical energy that disrupts the nerve transmissions along the outside of your 2 main bronchi. (Bronchi are the two main airways that connect your windpipe to your lungs). The goals of this therapy are to:

• permanently dilate the bronchi
• reduce mucus production
• decrease airway inflammation

As the electrical current passes into your lungs, it heats the outer surface of the bronchi. This prevents their nerves from sending signals to the lungs and stimulating the release of acetylcholine. Acetylcholine is a hormone that affects airway muscle tone, mucus secretion, and inflammation.

The procedure takes approximately an hour and a half and is done under general anesthesia.

But is it safe?

Two small studies to date have been conducted to specifically look at whether this procedure is safe, as well as effective. The first study was run in multiple locations over the course of a year, with a total of 22 patients. Their goals were freedom from sustained worsening of COPD for the whole year, as well as:

• technical feasibility
• improvements in pulmonary function
• higher exercise tolerance
• better quality of life

The result were encouraging. 93% of the participants were able to use TLD and it was proven to be safe and well-tolerated in 95% of the cases. Plus, the bronchial wall effects were successful. Researchers concluded that TLD is promising, but that further study would be needed.

The second study, reported in the International Journal of Chronic Obstructive Pulmonary Disease this past December, was designed to further test the safety and effectiveness of targeted lung denervation. They also aimed to prove that TLD could (and should) be safely administered in both lungs at one time, as opposed to being staged over several treatments, as it was in the first study.

This most recent study only involved 15 patients (47% of whom were male) with moderate to severe COPD, also over a 1-year period. The goals of treatment were the same as in the first study. The results were even more promising: 100% of the patients studied underwent TLD safely and had no worsening of their COPD during the study period. None of the patients had any complications from TLD. There were also similar improvements in exercise tolerance and quality of life to the first study.

In Summary

COPD can be a difficult disease to treat and is a global health problem. Every patient is different and may respond differently to the gamut of treatments used for COPD. Current treatments are not always as effective as we might desire. So, research such as these studies about targeted lung denervation are exciting and offer hope to COPD patients.

However, the scope of both these studies was narrow. More research will be needed to determine whether TLD is a procedure that can be introduced into mainstream COPD treatment. Researchers from the most recent study caution that further research will need to focus on the following aspects of TLD:

• optimizing the energy dose
• further refining the procedure
• studying potentially additive effects of TLD on top of other COPD treatments
• identifying which patients will benefit most from TLD

Hopefully targeted lung denervation will be available to improve the life of at least some COPD patients in the fairly near future.