Emphysema Clinical Trial
Official title:
Lung Volume Reduction in COPD Patients With an Inhomogeneous Severe Emphysema Located in the Upper Lobes, by Injecting Warm Saline Through the Bronchoscope Channel
Aim: To evaluate feasibility, safety and efficacy of relatively simple approach of
bronchoscopic lung volume reduction (LVR) technology, independent of collateral ventilation.
Description: Patients with severe upper lobes heterogeneous emphysema, undergo unilateral
bronchoscopic installation of saline thermal energy 50-55 ºC intending to induce an
inflammatory airway and parenchymal injury and consequently fibrotic response resulting in
LVR;
Inclusion criteria:
1. Age 40-75 unlimited sex. 20 subjects
2. chronic obstructive pulmonary disease (COPD), GOLD 3-4 (global obstructive lung
disease).
3. CT scan of lung and included high resolution slices. Demonstrating emphysematous,
bullotic changes in the upper lobes.
4. Pulmonary function tests results- total lung capacity(TLC)>110%, residual
volume(RV)>150%, diffusion of lung CO(DLCO)<80%,forced expiratory volume 1
second(FEV1):15-45%.
5. 6 minute walking distance (6MWD)> 140 meters.
Exclusion criteria:
1. Active ischemic heart disease, significant arrhythmia. ejection fraction (EF) <40%.
2. COPD that cause carbon bioxide(CO2) retention above 50 mm Hg and / or oxygen saturation
at rest below 88%.
3. Pulmonary hypertension> 45 mmHg, according to the Echo Test.
4. . Cancer treatment with chemotherapy / radiation or expected life expectancy of less
than two years.5. Pregnancy.
Methods: . A. Patient preparation and sedation as in diagnostic bronchoscopy. Sedation will
be based on midzoln + demerol. The patients will be treated prior the treatment with
Inhalation with salbutamol ans ipratropium bromide. Flexible bronchoscope with outer
diameter 5 mm is introduced to the targated upper lobe, and placed in wedged position. This
is followed by installion of 0.9% natriu, chloride(NaCl) at a temperature of 55ºC exit
temperature 50ºC) in portions of 40 ml to 200 ml (in bronchoalveolar lavage up to 300 ml is
acceptable. The patient is placed in horizontal position, and continuous ECG blood pressure.
Oxygen saturation are monitored. This monitoring will be continue at least 2 hours after
treatment. A chest x-ray is followed and the patient remain in the department for overnight.
Tracking: Minimum of 6 months - Outpatient follow up include in addition to physical
examination extended pulmonary function test and after 3-6 months. low radiation chest CT.
;
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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