2 The condition, current treatments and procedure

2 The condition, current treatments and procedure

The condition

2.1 Chronic obstructive pulmonary disease (COPD) includes emphysema and chronic bronchitis. It's a common condition that mostly affects middle-aged and older adults. Approximately 4.5% of over 40s in the UK have diagnosed COPD. The main cause of COPD is smoking. The main symptoms are breathlessness, a persistent cough and wheezing, and frequent chest infections. COPD gradually gets worse over time and people can have sudden flare-ups (exacerbations).

Current treatments

2.2 Although the damage to the lungs caused by COPD is permanent, treatment can help slow disease progression. Treatments include stopping smoking, pulmonary rehabilitation, inhaled beta‑2 agonists, antimuscarinic and steroid inhalers, oral medication such as bronchodilators, mucolytics and steroids, and oxygen. In a very small number of people, surgery or lung transplant may be indicated.

The procedure

2.3 In COPD, acetylcholine released from parasympathetic airway nerve fibres mediates smooth muscle tone, reflex bronchoconstriction, mucus hyper-secretion and airway inflammation. This procedure disrupts parasympathetic signalling to the lungs and decreases neuronal release of acetylcholine. The aim is to produce permanent bronchodilation, decrease mucus production and improve breathing.

2.4 Endobronchial nerve ablation is a minimally invasive outpatient procedure carried out under general anaesthesia. A bronchoscope is used to visualise the airways and a dual-cooled radiofrequency (RF) catheter, which has a balloon and an electrode on the end, is positioned in the distal mainstem bronchus. Once in position, coolant is passed through the catheter and the balloon inflates, pressing the electrode against the airway wall. RF energy is then delivered from the electrode to ablate the parasympathetic nerves that run along the outside of the mainstem bronchus. The balloon is then deflated and rotated, and the ablation repeated until the whole circumference of the bronchus has been treated. Both main bronchi are treated during a single procedure. Most patients return home on the day of the procedure.

  • National Institute for Health and Care Excellence (NICE)