This review highlights bronchoscopic lung volume reduction as a minimally invasive treatment for emphysema, with established techniques like endobronchial valves and thermal vapor ablation improving symptoms by targeting hyperinflated lung regions. However, their effectiveness is limited in patients with homogeneous disease or collateral ventilation. Emerging therapies – such as sealants, coils, and airway stents – show promise in expanding treatment options, though further research is needed to confirm their long-term outcomes and optimal use.
Tana A, Shah PL. Advanced bronchoscopy therapies for emphysema: current state and future potentials. Curr Opin Pulm Med. 2026 Mar 1;32(2):121-128. doi: 10.1097/MCP.0000000000001236. Epub 2025 Nov 19. PMID: 41606822.
Advanced bronchoscopy therapies for emphysema: current state and future potentials – PubMed
This prospective multicentre study evaluated the effectiveness and safety of shape-sensing robotic-assisted bronchoscopy combined with cone beam CT for sampling pulmonary nodules. It found high tool-in-lesion rates and strong diagnostic accuracy (92%) and sensitivity (95.5%), including for small and anatomically challenging nodules, with a low rate of serious complications.
Chan LT, Lau KKW, Orton CM, Temov K, Tana A, Baboolal I, Karir A, Agaoglu E, Garner J, Kalyal A, Lapuente M, Ttofia F, Shah PL. Tool in lesion verification of shape-sensing robotic-assisted bronchoscopy with cone beam CT in sampling peripheral pulmonary nodules. Thorax. 2025 Dec 18:thorax-2025-223631. doi: 10.1136/thorax-2025-223631. Epub ahead of print. PMID: 41391887.
This randomized, sham-controlled trial (AIRFLOW-3) assessed whether targeted lung denervation improves outcomes in patients with COPD compared to optimal medical therapy. While it did not reduce exacerbations (primary endpoint), it showed modest improvements in dyspnoea, with post hoc analyses suggesting potential benefit in a specific airway-predominant patient subgroup.
Shah PL, Slebos DJ, Sue R, Bhatt SP, Ghattas C, Strange C, Degano B, Valipour A, Eisenmann S, De Cardenas J, Marquette CH, Soto-Soto J, Sciurba FC, Conway F, Tonkin J, Tana A, Marchetti N, Hartman JE, Heluain V, Guibert N, Criner GJ. Randomized Sham-controlled Trial of Targeted Lung Denervation in Patients with Chronic Obstructive Pulmonary Disease (AIRFLOW-3). Am J Respir Crit Care Med. 2025 Dec;211(12):2318-2329. doi: 10.1164/rccm.202502-0404OC. PMID: 40920914; PMCID: PMC12700255.
Status: Active, not recruiting.
The Ryme Medical Lung Denervation System is a new, experimental device that consists of a balloon catheter to freeze the overactive nerves in COPD to improve symptoms of COPD. This first in human study will include up to 40 patients in 4 sites in Europe and the UK, with a 12-month post procedure follow up for patients.
Link: https://clinicaltrials.gov/study/NCT05967091
Status: Active, not recruiting.
Emphysema is a lung disease that results from damage to the walls of the alveoli of the lungs. A blockage (obstruction) may develop, which traps air inside the lungs. The Apreo Implant is designed to open lung airways, allowing trapped air to escape, thereby reducing hyperinflation of the lungs. This multi-centre study is being carried out to assess the safety, feasibility and preliminary efficacy of the Apreo Implant for severe emphysema in up to 60 participants.
Link: https://clinicaltrials.gov/study/NCT05949645
Status: Active, not recruiting.
Bronchial Rheoplasty (investigational treatment) is designed to remove the tissue layers of the airway where the abnormal mucus cells are located. It is expected the airway tissue will heal more normally after treatment, and thereby reduce the symptoms associated with chronic bronchitis, such as cough and phlegm. The purpose of the study is to assess the safety and effectiveness of Bronchial Rheoplasty for the treatment of the symptoms of chronic bronchitis in adult COPD patients with moderate to severe chronic bronchitis. A total of 270 patients will be randomised in multiple centres including in Europe, United States and Canada. study centres and up to 10 centres outside the US (Canada and Europe) and they will be followed up for 2 years.
Link: https://clinicaltrials.gov/study/NCT04677465
Status: Active, not recruiting.
The RejuvenAir® System is a cryosurgical device that applies medical-grade liquid nitrogen to the treatment area to ablate tissue in the airways that causes cough and sputum production and allow regrowth of healthier epithelial cells to reduce the symptoms associated with chronic bronchitis. This is study designed to demonstrate the safety and effectiveness of the RejuvenAir® System for the treatment of adults with a diagnosis of chronic bronchitis and COPD comparing treatment to Sham Control Arm in a 2:1 randomised control trial. Those randomized to the Sham Control Arm will have the option to cross over to the treatment arm after the 12 month follow up visit. Patients in this study will be followed for 24 months.
Link: https://clinicaltrials.gov/study/NCT03893370
Status: Recruiting
This study involves the use of the Creo Medical MicroBlate Flex instrument, to heat and destroy lung tumour cells using microwave energy. In this study, we are investigating whether the ablation instrument can be used effectively to treat lung tumours or tumours that have spread to the lungs. If successful, using this technology may mean future patients may not need to undergo surgical removal of these types of lung tumours. Up to 18 subjects (plus replacements) are enrolled in the study. All participants will undergo the microwave ablation procedure, followed by a surgical resection of the tumour up to 21 days after ablation.
Link: https://clinicaltrials.gov/study/NCT06869122?id=nct06869122&rank=1
Status: Active. Recruiting completed.
This is a post-market, prospective, single-arm, multicentre, non-randomized study which enrolling up to 32 subjects in total (plus replacements). The primary purpose of this study is to evaluate the safety and feasibility of the Creo Medical MicroBlate™ Flex AB1 instrument used with the AB1 electrosurgical system in patients undergoing bronchoscopic microwave ablation of peripheral lung nodules. Subjects include patients with a suitable soft tissue lung lesion, who are not surgical candidates or decline surgery. Subjects who meet the eligibility requirements undergo a pre-procedural assessment, a bronchoscopy procedure that includes ablation treatment with MicroBlate™ Flex AB1, a post-procedural assessment and 6 follow-up visits at, 7 days (by phone call or in person), 31-45 days, 3 months, 6 months, 9 months and 12 months.
Link: https://clinicaltrials.gov/study/NCT05786625
Status: Recruiting.
This is a prospective, open label, multi center, single arm, first in human study to assess the safety and initial performance of EAS1 system for Irreversible Electroporation (IRE) ablation of lung cancer in subjects eligible for tumour resection. Up to 15 subjects (plus replacements) are enrolled in the study.
Subjects undergo ablation of the lung tumour via Irreversible Electroporation (IRE) method performed bronchoscopically, followed by resection of the tumour up to 19 days after the ablation.