Bronchoscopic Thermal Saline Ablation (BTSA) of Emphysematous Lung. A New Emphysema Therapy

Inclusion criteria: 1. Age 40-75 unlimited sex. 20 subjects 2. chronic obstructive pulmonary disease (COPD), GOLD 3-4 (global obstructive lung disease). 3. CT scan of lung and included high resolution slices. Demonstrating emphysematous, bullotic changes in the upper lobes. 4. Pulmonary function tests results- total lung capacity(TLC)\>110%, residual volume(RV)\>150%, diffusion of lung CO(DLCO)\<80%,forced expiratory volume 1 second(FEV1):15-45%. 5. 6 minute walking distance (6MWD)\> 140 meters. Exclusion criteria: 1. Active ischemic heart disease, significant arrhythmia. ejection fraction (EF) \<40%. 2. COPD that cause carbon bioxide(CO2) retention above 50 mm Hg and / or oxygen saturation at rest below 88%. 3. Pulmonary hypertension\> 45 mmHg, according to the Echo Test. 4. . Cancer treatment with chemotherapy / radiation or expected life expectancy of less than two years.5. Pregnancy. Methods: . A. Patient preparation and sedation as in diagnostic bronchoscopy. Sedation will be based on midzoln + demerol. The patients will be treated prior the treatment with Inhalation with salbutamol ans ipratropium bromide. Flexible bronchoscope with outer diameter 5 mm is introduced to the targated upper lobe, and placed in wedged position. This is followed by installion of 0.9% natriu, chloride(NaCl) at a temperature of 55ºC exit temperature 50ºC) in portions of 40 ml to 200 ml (in bronchoalveolar lavage up to 300 ml is acceptable. The patient is placed in horizontal position, and continuous ECG blood pressure. Oxygen saturation are monitored. This monitoring will be continue at least 2 hours after treatment. A chest x-ray is followed and the patient remain in the department for overnight. Tracking: Minimum of 6 months - Outpatient follow up include in addition to physical examination extended pulmonary function test and after 3-6 months. low radiation chest CT.