Efficacy and Safety of Broncho Muco Cleaner Balloon Dilation Therapy (EXERTION)

Inclusion Criteria: Adults of both sexes aged 40-75 years Being diagnosed with stage II-IV chronic bronchitis-predominant COPD according to the GOLD guideline To have quit smoking for at least 6 months mMRC 2 and above Receiving optimal medical treatment for COPD Being stable for at least 3 weeks To have completed 6 weeks of pulmonary rehabilitation before the first procedure Having sufficient mental and physical capacity to sign the voluntary consent form for the procedure. Exclusion Criteria: be under the age of 40 and over the age of 75 pregnant patients breastfeeding a child Being an active smoker Concurrent asthma Chronic kidney disease with GFR <30 ml/min Clinically significant arrhythmia, Left heart failure (EF<45) or pulmonary hypertension (PABs>45 mmHg) Liver cirrhosis Those who use anticoagulants or clopidogrel or equivalent drugs and cannot be stopped before and during the procedure, or the presence of bleeding diathesis 6 minutes walking test <100 meters FEV1<15% Those with positive early reversibility in pulmonary function tests Patients who do not regularly take 15lgu15in therapy for COPD Emphysema-predominant COPD patients Presence of active malignancy Partial CO2 pressure > 55mmHg or pO2<55 mmHg in room air Active pulmonary infection Pneumothorax or pulmonary surgery in the last 6 months Patients with other clinically significant lung disease other than COPD Those who have undergone a previous lung device procedure, including implanted emphysema stents, lung coil delivery, valves, lung denervation, or other devices for emphysema. Those taking > 10 mg of prednisolone per day Those with a known sensitivity to the drug (such as lidocaine, 15lgu15ine and benzodiazepines) needed to perform bronchoscopy.