Cross-Over Patient Outcomes for Targeted Lung Denervation in Moderate-to-Severe Chronic Obstructive Pulmonary Disease: AIRFLOW-2

Conway F, Tonkin J, Valipour A, Pison C, Schumann C, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Skowasch D, Johnson PJ, Slebos DJ, Shah PL; AIRFLOW-2 Trial Study Group.

Respiration. 2022;101(11):1069-1074. doi: 10.1159/000527455. Epub 2022 Oct 27. PMID: 36302345.

What is the Key Question?

  • Targeted lung denervation (TLD) is a bronchoscopic radiofrequency ablation procedure aimed at reducing parasympathetic activity associated with bronchoconstriction, airway hyper-reactivity and mucus production. The AIRFLOW-1 study had assessed safety aspects of the novel system in chronic obstructive pulmonary disease (COPD).
  • The AIRFLOW-2 trial was a multicentre, double-blind, sham-controlled, randomized cross-over trial to assess efficacy. 20 (of 39) patients crossed-over to TLD treatment. Sham-group participants were offered TLD treatment after 12.5 months of follow-up.

What is the Bottom Line?

  • COPD exacerbations reduced from 75% to 50% in the 12 months post-treatment, and COPD-related hospitalizations reduced from 25% to 10%.
  • Gastro-intestinal adverse effects seen in the initial AIRFLOW-1 trial led to ablation-dose adjustments, and were not a concern during this study.

Why read on?

  • This work shows the potential of TLD in reducing COPD exacerbations, associated with morbidity, mortality, quality-of-life and economic consequences. TLD is currently being assessed in a randomized controlled trial in the AIRFLOW-3 study.