Devices, methods, and systems to treat chronic bronchitis
Systems and methods involve abrading a patient lung airway wall to reduce mucus production therein. Exemplary techniques include rotationally and/or linearly oscillating an abrasive material against the airway wall so as to damage mucus producing tissues, for example by removing goblet cells, while destroying less than the entire airway wall. The abrasive material may be present on the surface of an expandable balloon body or another expandable device, which can be delivered to the patient treatment site via a bronchoscope. In some cases, the abrasion techniques can cause cell damage or death at a controlled or predetermined tissue depth.
1 . A method for detaching and removing an amount of mucus from an airway wall of a lung of a patient, comprising:
introducing an elongate member of a treatment device into the lung of the patient, the elongate member having an expandable abrasion feature comprising at least one strand or at least one spring element;
expanding the expandable abrasion feature until it makes contact with the airway wall of the lung, the airway wall comprising a basement membrane, a smooth muscle layer, and a cartilage layer;
detaching the amount of mucus from the airway wall of the lung of the patient with the at least one strand or the at least one spring element of the expandable abrasion feature, without separating the smooth muscle layer of the airway wall from the cartilage layer of the airway wall; and
removing the amount of mucus from the airway wall of the lung of the patient while the smooth muscle layer of the airway wall remains supported by the cartilage layer of the airway wall;
wherein the at least one strand comprises a member selected from the group consisting of a metallic wire, a fiber, and a braid, or wherein the at least one spring element comprises a member selected from the group consisting of shape memory material, a ferrous metal, a non-ferrous metal, a polymer, an elastomer, and a ceramic.
2 . The method according to claim 1 , wherein the expandable abrasion feature comprises an abrasive mesh, an abrasive geometrical feature, or an abrasive media selected from the group consisting of as alumina, carbide, sand, quartz, glass, metal, ceramic, plastic, carbon, diamond, oxide, silicon carbide, polymer, aluminum oxide, co-fused alumina zirconia, garnet, flint, cubic boron nitride, tungsten carbide, cobalt, glass-like polysaccharide, sintered sol-gel, styrene acrylonitrile co-polymer, alumina-zirconia, emery, and chromium (III).
3 . The method according to claim 2 , wherein the abrasion feature comprises the abrasive media, and wherein the abrasive media has a grit size within a range from about 2 microns in average particle diameter to 3000 microns in average particle diameter.
4 . The method according to claim 1 , wherein the elongate member comprises an expandable mechanism, and the expandable abrasion feature is disposed on the expandable mechanism, the method further comprising expanding the expandable mechanism.
5 . The method according to claim 1 , further comprising drawing the amount of mucus into a filter trap using a vacuum source.
6 . The method according to claim 1 , wherein the expandable abrasion feature is mounted on a guidewire.
7 . The method according to claim 6 , wherein the guidewire comprises a blunt distal tip.
8 . The method according to claim 6 , wherein the guidewire is advanced within the patient's airway that is zero generation or higher.
9 . The method according to claim 6 , wherein the guidewire comprises a wire cable.
10 . The method according to claim 6 , wherein the guidewire has a diameter within a range of 0.005 inches to 0.100 inches.
11 . The method according to claim 1 , wherein the elongate member of the treatment device comprises a guidewire.
12 . The method according to claim 1 , wherein the expandable abrasion feature is delivered through a catheter.
13 . The method according to claim 1 , wherein the expandable abrasion feature comprises the at least one strand.
14 . The method according to claim 13 , wherein the at least one strand comprises the metallic wire.
15 . The method according to claim 13 , wherein the at least one strand comprises a cross-section selected from the group consisting of a round cross-section, a square cross-section, and a rectangular cross-section.
16 . The method according to claim 13 , wherein the at least one strand comprises a shape selected from the group consisting of a helical shape, a random shape, an egg-beater shape, a sinusoidal shape, and a troposkein shape.
17 . The method according to claim 13 , wherein the at least one strand comprises multiple strands.
18 . The method according to claim 13 , wherein the at least one strand comprises nitinol.
19 . The method according to claim 13 , wherein the at least one strand comprises a shape memory material.
20 . The method according to claim 13 , wherein the at least one strand has at least one etched surface.
21 . The method according to claim 13 , wherein the at least one strand comprises the metallic wire, and the metallic wire comprises a member selected from the group consisting of stainless steel, titanium, and a nickel based alloy.
22 . The method according to claim 21 , wherein the metallic wire comprises the nickel based alloy, and wherein the nickel based alloy comprises nitinol.
23 . The method according to claim 13 , wherein the at least one strand comprises the fiber, and wherein the fiber is a monofilament fiber or a multifilament fiber.
24 . The method according to claim 13 , wherein the at least one strand comprises the fiber, and wherein the fiber comprises a member selected from the group consisting of a polymer, a ceramic, and a glass.
25 . The method according to claim 13 , wherein the at least one strand comprises the fiber, and wherein the fiber comprises a member selected from the group consisting of a plastic, Kevlar®, a carbon fiber, nylon, polyurethane, and polypropylene.
26 . The method according to claim 13 , wherein the at least one strand is a component of a nitinol wire basket.
27 . The method according to claim 13 , wherein the at least one strand comprises a member selected from the group consisting of a round-section wire, a square-section wire, and a rectangular-section ribbon.
28 . The method according to claim 13 , wherein the at least one strand is coupled with and positioned between a connector hub and a distal end.
29 . The method according to claim 1 , wherein the expandable abrasion feature comprises the at least one spring element.
30 . The method according to claim 29 , wherein the at least one spring element has an abrasive edge that is provided in the absence of a separate abrasive material.
31 . The method according to claim 29 , wherein the at least one spring element comprises a round wire.
32 . The method according to claim 29 , wherein the at least one spring element comprises a flattened shape.
33 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand and press against the wall of the lung airway.
34 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand and press against the wall of the lung airway, and wherein the airway wall is of an airway having a diameter within a range from about 2 mm to about 25 mm.
35 . The method according to claim 1 , wherein the expandable abrasion feature is operable to change diameter from a first value to a second value that are within a range from 0.01 mm to 28 mm.
36 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand by actuation of a control mechanism.
37 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand by actuation of a pull wire of a control mechanism.
38 . The method according to claim 1 , wherein the patient presents with goblet cell hyperplasia.
39 . The method according to claim 1 , wherein the patient presents with bronchitis.
40 . The method according to claim 1 , wherein the patient presents with frequent coughing episodes.
41 . The method according to claim 1 , wherein the patient presents with a low arterial blood oxygen in the bloodstream.
42 . The method according to claim 1 , wherein the patient presents with a low walking distance in 6 minutes.
43 . The method according to claim 1 , wherein the patient presents with a low forced expiratory volume.
44 . The method according to claim 1 , wherein the patient presents with a high residual volume.
45 . The method according to claim 1 , wherein the patient presents with a high trapped lung gas volume during or after expiration.
46 . The method according to claim 1 , wherein the elongate member is received in a working channel exit port of a bronchoscope, and wherein the bronchoscope is steerable.
47 . The method according to claim 46 , wherein the bronchoscope has a working channel having a diameter that is 3.2 mm or smaller.
48 . The method according to claim 46 , wherein the bronchoscope is steerable by an electrical driver.
49 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand by actuation of a handle of a control mechanism.
50 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand by actuation of a motorized driver of a control mechanism.
51 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand via robot operation of a control mechanism.
52 . The method according to claim 1 , wherein the expandable abrasion feature is operable to move along or within the airway wall via robot operation of a control mechanism.
53 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand or move along or within the airway wall via robot motor or magnetic actuator operation of a control mechanism.
54 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand by actuation of a control mechanism having an electrically actuated driver.
55 . The method according to claim 1 , wherein the expandable abrasion feature is operable to expand driven by stored strain energy.
56 . A method for detaching and enabling removal of an amount of mucus from an airway wall of a lung of a patient, comprising:
introducing an elongate member of a treatment device into the lung of the patient, the elongate member having an expandable abrasion feature comprising at least one strand or at least one spring element;
expanding the expandable abrasion feature until it makes contact with the airway wall of the lung, the airway wall comprising a basement membrane, a smooth muscle layer, and a cartilage layer; and
detaching the amount of mucus from the airway wall of the lung of the patient with the at least one strand of the expandable abrasion feature or the at least one spring element of the expandable abrasion feature, without separating the smooth muscle layer of the airway wall from the cartilage layer of the airway wall, so as to enable removal of the amount of mucus from the airway wall of the lung of the patient while the smooth muscle layer of the airway wall remains supported by the cartilage layer of the airway wall;
wherein the at least one strand comprises a member selected from the group consisting of a metallic wire, a fiber, and a braid, or wherein the at least one spring element comprises a member selected from the group consisting of shape memory material, a ferrous metal, a non-ferrous metal, a polymer, an elastomer, and a ceramic.
57 . A method for treating an airway wall of a lung of a patient to increase time between chronic obstructive pulmonary disease (COPD) exacerbation events, comprising:
introducing an elongate member of a treatment device into the lung of the patient, the elongate member having an expandable abrasion feature comprising at least one strand or at least one spring element;
expanding the expandable abrasion feature until it makes contact with the airway wall of the lung, the airway wall comprising a basement membrane, a smooth muscle layer, and a cartilage layer; and
detaching an amount of mucus from the airway wall of the lung of the patient with the at least one strand of the expandable abrasion feature or the at least one spring element of the expandable abrasion feature, without separating the smooth muscle layer of the airway wall from the cartilage layer of the airway wall, so as to enable removal of the amount of mucus from the airway wall of the lung of the patient while the smooth muscle layer of the airway wall remains supported by the cartilage layer of the airway wall;
wherein the at least one strand comprises a member selected from the group consisting of a metallic wire, a fiber, and a braid, or wherein the at least one spring element comprises a member selected from the group consisting of shape memory material, a ferrous metal, a non-ferrous metal, a polymer, an elastomer, and a ceramic.