What question did this study set out to answer?

Evaluate the efficacy and safety of targeted lung denervation in reducing severe exacerbations in COPD.

May 20, 2026American Journal of Respiratory and Critical Care Medicine0 citations

B24-15 Targeted Lung Denervation in Moderate to Severe Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis of Randomized Trials

Key Points

Evaluate the efficacy and safety of targeted lung denervation in reducing severe exacerbations in COPD.
Conducted a systematic review and meta-analysis of randomized controlled trials; identified 5 studies.
Included 2 trials meeting criteria for pooled analysis, using random-effects models for continuous and binary outcomes.
Primary outcome measured was severe COPD exacerbations, with secondary outcomes including moderate/severe exacerbations and adverse events.
TLD significantly reduced the risk of severe COPD exacerbations (HR = 0.37; 95% CI 0.20-0.69; p = 0.002).
Moderate/severe exacerbations trended lower (HR = 0.69; 95% CI 0.44-1.09).
Early respiratory adverse events were significantly less frequent with TLD (RR = 0.45; 95% CI 0.28-0.72; p = 0.001).

Abstract

Abstract Rationale Cholinergic hyperactivity contributes to airflow limitation and exacerbation risk in COPD. Targeted lung denervation (TLD)—a bronchoscopic radiofrequency ablation of parasympathetic pulmonary nerves—has emerged as a novel adjunctive therapy. Individual randomized trials (AIRFLOW program) have reported promising reductions in exacerbations, but pooled efficacy and safety data are lacking. Methods A systematic review and meta-analysis were conducted of all randomized controlled trials evaluating TLD in moderate-to-severe COPD. Searches of PubMed, Embase, and CENTRAL identified 5 studies, of which 2 (AIRFLOW-2 RCT and its 2-year follow-up) met inclusion criteria for pooled analysis while all 5 were considered for synthetic analysis. Random-effects models (DerSimonian-Laird) were applied for continuous (mean difference, MD) and binary outcomes (risk ratio, RR) with 95% confidence intervals (CIs). Primary outcome: severe COPD exacerbations. Secondary outcomes: moderate/severe exacerbations, respiratory adverse events, FEV1, and SGRQ change. Results Across 164 patients, TLD significantly reduced the risk of severe COPD exacerbations (pooled HR = 0.37; 95% CI 0.20-0.69; p = 0.002; I² = 0%), corresponding to a 63% relative risk reduction. Moderate/severe exacerbations trended lower (HR = 0.69; 95% CI 0.44-1.09). Early respiratory adverse events (≤ 90 days) were significantly less frequent with TLD (RR = 0.45; 95% CI 0.28-0.72; p = 0.001). No difference was observed in FEV1 change (MD = +25 mL; p = 0.64) or SGRQ score (MD = -0.8; p = 0.71). No procedure-related deaths occurred. Long-term follow-up confirmed durable safety and stable lung function. Conclusions TLD is a safe, minimally invasive bronchoscopic therapy that significantly reduces severe COPD exacerbations without impairing lung function or quality of life. These findings support cholinergic pathway modulation as a viable adjunct to maximal inhaled therapy. Ongoing AIRFLOW-3 results will be pivotal in defining clinical integration of TLD into COPD management algorithms. This abstract is funded by: None

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Cite This Study

Kumar et al. (Fri,) studied this question.

synapsesocial.com/papers/6a0d5013f03e14405aa9b9cc https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.1774

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