Evaluating the Safety and Feasibility of TLD for the Treatment of Severe Asthma

A pRospective, Multicenter, Single-arm Study EvaLuating the Safety and feasIbility of Targeted Lung Denervation (TLD) for the trEatment oF Severe Asthma

Prospective, multicenter, single-arm (non-randomized) study of Targeted Lung Denervation (TLD) Therapy in subjects with severe asthma.

Prospective, multicenter, single-arm (non-randomized) study. All patients will undergo a run in period on optimal medical therapy as part of eligibility testing. Final determination to initiate treatment will be made after initial airway inspection. A total of 20 patients will be treated. Inflammatory biomarkers (washes and brushes) will be collected in all patients and bronchial biopsies will be collected from the last 10 patients at the time of treatment and at 90-days post-treatment. All patients will be prescribed peri-procedural antibiotics and steroids to minimize procedural risks. All patients will be provided a mobile handheld spirometer to measure and record daily peak expiratory flow both before and after treatment to monitor lung function. Patient follow-up will be conducted out to 3 years.

Inclusion Criteria:

• Patient has provided written informed consent;
• Diagnosis of severe asthma as defined by the 2018 GINA Report, and are taking regular maintenance medication as specified in the study protocol;
• Pre-bronchodilator FEV1 ≥50% predicted after a 4 week medication run-in;
• Subject has at least two days of asthma symptoms during the 4-weeks of the Baseline Diary Period;
• Women of child bearing potential must have a negative pregnancy test and agree not to become pregnant for the duration during the study;
• Non-smoker for at least 6 months and agree to continue not smoking for duration of the study;
• Patient is a candidate for bronchoscopy in the opinion of the physician or per hospital guidelines;
• Patient is a candidate to undergo methacholine challenge testing;
• Patient is willing, able and agrees to complete all protocol required baseline and follow up testing and comply with medication requirements.

Exclusion Criteria:

• In the 24 months prior to enrollment, the subject has: been intubated for asthma, had intensive care unit (ICU) admission(s) for asthma, or been treated with immunosuppressant therapy for any reason (steroids excluded);
• In the 12 months prior to enrollment, the subject has had: ≥4 lower respiratory tract infections requiring antibiotics or ≥4 hospitalizations for asthma exacerbations;
• In the 3 months prior to enrollment, the subject has taken/used an opioid(s);
• In the 6 weeks prior to enrollment the subject has had a lower respiratory tract infection or asthma exacerbation that required: antibiotics, unscheduled physician visits for asthma care, changes in use of asthma maintenance medication, taking of rescue medication over normal dose in a 24-hour period for asthma symptoms and a steroid burst (pulse);
• Current use of greater than 10 mg of oral steroids per day at the time of enrollment;
• History of poor medication compliance;
• Prior lung or chest procedure;
• Other chronic pulmonary disorders associated with asthma-like symptoms, including (but not limited to) cystic fibrosis, chronic obstructive pulmonary disease, chronic bronchitis, vocal chord dysfunction, eosinophilic granulomatosis with polyangiitis (EGPA) or interstitial lung disease that is the sole cause of asthma symptoms, severe scoliosis or chest wall deformities that affect lung function, or congenital disorders of the lungs or airways;
• Pre-existing diagnosis of pulmonary hypertension as defined in the study protocol;
• Uncontrolled diabetes as evidenced by an HbA1c > 7%;
• Patient has an implantable electronic device;
• Known contraindication or allergy to anticholinergic drugs or components;
• Known contraindication of allergy to medications required for bronchoscopy, general anesthesia or peri-procedural therapy that cannot be medically controlled;
• Patient is unable to stop blood thinning medication for 7 days prior and 7 days after procedure;
• Documented history of untreated severe obstructive sleep apnea;
• Patient has any disease or condition that might interfere with completion of a procedure or this study or patient safety;
• Screening chest CT scan reveals bronchi anatomy cannot be fully treated with the available catheter sizes or discovery of a pulmonary nodule requiring follow-up or intervention unless proven benign;
• Patients who had abdominal surgical procedures on stomach, esophagus or pancreas;
• Patients with a Gastroparesis Cardinal Symptom Index (GCSI) score ≥ 18 prior to treatment;
• Patient is currently enrolled in another clinical trial that has not completed follow-up.