Dr Jonathan Kurman Outlines Emerging Bronchoscopic Therapies for COPD

Hope is on the horizon for patients living with chronic obstructive pulmonary disease (COPD). CHEST 2024 in Boston featured a session highlighting emerging bronchoscopic therapies. Traditionally, COPD management has relied on bronchodilators, pulmonary rehabilitation, steroids, and invasive options like lung transplantation or lung volume reduction surgery, leaving a gap in minimally invasive treatments.

Jonathan Kurman, MD, assistant professor of medicine at the Medical College of Wisconsin and the director of Interventional Pulmonology at Froedtert Hospital, presented on the topic and is an investigator in 4 of the ongoing clinical trials in their initiation stage.

This transcript has been lightly edited for clarity.

Transcript

What was the focus of your presentation on emerging bronchoscopic management of COPD at CHEST?

Our session was entitled "COPD Beyond Bronchodilators." The focus of our session was on bronchoscopic management of COPD, and this is an entirely new area. Historically, we've been reliant upon bronchodilators, pulmonary rehab, steroids, and then we've had much more invasive management strategies like lung transplantation or lung volume reduction surgery for patients who have severe emphysema. But we really haven't had anything in the middle, and with bronchoscopic interventions for COPD, now you have an entirely new category of treatment options that are minimally invasive.

There is one that's currently available commercially in the US, that's bronchoscopic lung volume reduction, abbreviated BLVR, most commonly, and that's implanting one-way valves for patients who have emphysema with hyperinflation. That laid the groundwork for what's coming next.

Now, for patients who wanted to pursue bronchoscopic lung volume reduction but were ineligible due to what's called collateral ventilation, which is simply airflow between the target lobe and the adjacent lobe, or lobes, you're going to have bronchoscopic fissure completion, in which we instill a polymer sealant into the airway to remedy any visual defects. That's for emphysema.

For our chronic bronchitis patients, we're studying bronchial rheoplasty and metered spray cryotherapy. These are both bronchoscopic treatment modalities that target goblet cell hyperplasia, which is the main pathology present in folks who have chronic bronchitis, and this helps decrease mucus hypersecretion—the primary driver of their chronic cough.

The other big area of interest is reducing COPD exacerbation frequency. For this, we're studying targeted lung denervation, in which we use radio frequency energy to ablate the vagal nerve plexus in the bilateral main stem bronchi. This reduces some of the inappropriate feedback between the brain and the lungs that can precipitate bronchoconstriction inappropriately.

All of the things I've talked about, except for bronchoscopic lung volume reduction, are currently in the clinical trial phase. But I'm hopeful that the trial data will be positive and that these treatment modalities will become part of standard commercial care in the near future.

I know patients are very interested in this, and so they are learning about it. They're being proactive, and I imagine that they'll be inquiring about these modalities as they become more widely known. So, I just want providers to be aware of what's coming down the pike, both for their own knowledge and so that they can accurately respond to patient-driven inquiries.