Age

35–90

Sex

ALL

Healthy volunteers

Not accepted

Age \> 35 years
Large bulla on CT scan where bullectomy is contraindicated or is actively avoided.
Hyperinflation - TLC ≥100% predicted, RV ≥150% predicted
Exertional breathlessness (mMRC \>0)
Optimum COPD treatment for at least 6 weeks
No COPD exacerbation for at least 6 weeks
Fewer than 3 admissions for infective exacerbations in the preceding 12 months
Written informed consent

Inability to obtain informed consent
Co-morbidities that would render bronchoscopy or sedation unsafe.
Anaemia or other reasons precluding venesection.
Clinically significant bronchiectasis
Arrhythmia or cardiovascular disease that poses a risk during procedure
Lung nodule requiring further investigation or treatment
Subject taking clopidogrel, warfarin, or other anticoagulants and unable to abstain for 5 days pre-procedure

Bronchoscopic Intrabullous Autologous Blood Instillation (BIABI) for Emphysema