Endobronchial thermal liquid ablation for treating emphysema

Inclusion Criteria:

* Age ≥ 40 years old
* Diagnosis of COPD with FEV1/FVC less than 0.7 post-bronchodilation
* Post-bronchodilator Forced Expiratory Volume (FEV1) ≥ 20% and ≤ 49% of predicted value
* Total lung capacity (TLC) ≥ 100% predicted
* Residual volume (RV) ≥ 175% predicted
* 6 Minute Walk Distance (6MWD) ≥ 140 meters
* Dyspnea scoring ≥ 1 on the modified Medical Research Council scale (mMRC)
* Blood gas values of PCO2 ≤ 55 mmHg; PO2 ≥ 45 mmHg on room air
* Optimized medical management (consistent with GOLD guidelines) as confirmed by the Investigator
* Non-smoking for 3 months prior to study enrollment, as confirmed by lab testing
* Participant must engages in physical exercise beyond activities of daily living (i.e., a walking program, pulmonary rehabilitation) on n a regular basis for more than 6 weeks prior to enrollment and agree to continue the activity throughout study participation
* Participant must live within approximately 1 hour of the study hospital, or live within 1 hour of adequate regional care, or be willing to remain in the hospital for at least five days post-procedure
* Vaccinated for COVID-19, pneumococcus, and influenza (per European Union and Member State guidelines) or documented clinical intolerance or documented patient refusal
* Cognitively able to provide written informed consent and willing to comply with study requirements
* Severe emphysematous lung subsegments eligible for ETLA treatment

Exclusion Criteria:

* Body mass index (BMI) \< 16 kg/m\^2 or ≥ 33 kg/m\^2
* DLCO \< 20% predicted
* Chronic bronchitis as defined by cough and sputum production for at least 3 months per year for two consecutive years, in the absence of other conditions that can explain these symptoms
* 75ml or greater sputum production per day most days of the week
* Greater than two hospitalizations for COPD exacerbations and/or pneumonia in the 12 months prior to enrollment
* Diagnosis of asthma that is confirmed according to the Global Initiative for Asthma (GINA) guidelines
* Prior lung volume reduction via endobronchial valves(s), coil(s), vapor and/or polymer. Patients whose valves have been removed \> 3 months previously can be treated if a baseline bronchoscopy reveals no airway obstruction or obvious tissue granulation and the reason for valve removal was not for complications e.g., Pneumonia, severe exacerbation, or pneumothorax.
* Pulmonary hypertension
* Alpha-1 antitrypsin deficiency
* Uncontrolled diabetes mellitus
* Prior heart or lung transplant
* Myocardial infarction or stroke within the 12 months of enrollment
* Diagnosis of heart failure
* Heart failure requiring hospitalization, within 6 months prior to enrollment
* History of bleeding disorders or enhanced predisposition to bleeding
* History of severe/massive hemoptysis defined as \>200ml of blood loss in \< 24 hours
* Unable to discontinue anti-coagulants or platelet inhibitors (acetylsalicylic acid \[ASA\]and non-ASA, including low dose) for at least 7 days prior to each procedure (or as per physician discretion based on the specific agent) and for at least 6 weeks after each procedure
* Daily systemic steroids equivalent to \> 15mg prednisolone
* Immunosuppressive drugs, such as for the treatment of cancer, autoimmune disease, or prevention of tissue/organ rejection
* Pregnant, lactating, or women of childbearing potential that plan to become pregnant within the study duration
* Currently enrolled in another trial studying an experimental treatment
* Any disease or condition likely to limit survival to less than one year
* Concomitant illnesses or medications that may pose a significant increased risk for complications following treatment with ETLA
* Any condition that would interfere with evaluation or completion of the study including study assessments and procedures, including bronchoscopy.
* Active aspergillus infection
* Clinically significant bronchiectasis as determined by the Investigator
* Radiological evidence of bronchiectasis in target region(s) and/or cystic radiological bronchiectasis in any region of the lungs
* Clinically significant pulmonary fibrosis
* Lung nodule not proven stable unless proven to have benign pathology
* Large bulla (defined as \> 1/3 volume of a lung)
* Prior Lung Volume Reduction Surgery (LVRS), bullectomy, or lobectomy
* The remaining lung tissue NOT targeted for ETLA treatment is too highly diseased
* Active respiratory infection or recent respiratory infection with resolution \< 4 weeks prior to screening or procedure
* Recent COPD exacerbation within \< 6 weeks prior to screening or procedure