Bronchial Rheoplasty for Chronic Bronchitis: A Systematic Review of Initial Human Studies

Abstract

Introduction: Chronic bronchitis (CB) features mucus hypersecretion from goblet cell hyperplasia. Bronchial rheoplasty, a novel endoscopic procedure using pulsed electric fields, ablates hyperplastic epithelium to reduce mucus production. This review summarizes early efficacy and safety.
Methods: Systematic search of MEDLINE, Embase, and clinical trial registries (2019–2024) for prospective human studies of bronchial rheoplasty in CB patients (symptoms ≥2 years, post-bronchodilator FEV1 ≥30%). Outcomes: change in Cough and Sputum Assessment Questionnaire (CASA-Q) and serious adverse events (SAEs).
Results: Two single-arm studies (n=58) and one randomized sham-controlled trial (n=42) were identified. At 6 months, CASA-Q improved by 18.4 points (95% CI 12.1–24.7) vs baseline in treated patients. Sham-adjusted difference was 11.2 points (p=0.02). SAEs: 5.7% (hemoptysis requiring hospitalization, all self-limited). Histology (from 12 patients) showed reduced goblet cell density by 58% (p<0.001).
Discussion: The procedure appears to deliver non-thermal ablation, preserving airway structure. However, follow-up beyond 1 year is lacking, and re-treatment rates unknown. Most studies excluded very severe COPD (FEV1<30%), limiting generalizability.
Conclusions: Bronchial rheoplasty shows promise for refractory CB symptoms, with reasonable short-term safety. Larger sham-controlled trials with longer follow-up are needed.