The REDUCE EU Study - Endobronchial Thermal Liquid Ablation (ETLA) for the Treatment of Emphysema

Inclusion Criteria: * Age ≥ 40 years old * Diagnosis of COPD with FEV1/FVC less than 0.7 post-bronchodilation * Post-bronchodilator Forced Expiratory Volume (FEV1) ≥ 20% and ≤ 49% of predicted value * Total lung capacity (TLC) ≥ 100% predicted * Residual volume (RV) ≥ 175% predicted * 6 Minute Walk Distance (6MWD) ≥ 140 meters * Dyspnea scoring ≥ 1 on the modified Medical Research Council scale (mMRC) * Blood gas values of PCO2 ≤ 55 mmHg; PO2 ≥ 45 mmHg on room air * Optimized medical management (consistent with GOLD guidelines) as confirmed by the Investigator * Non-smoking for 3 months prior to study enrollment, as confirmed by lab testing * Participant must engages in physical exercise beyond activities of daily living (i.e., a walking program, pulmonary rehabilitation) on n a regular basis for more than 6 weeks prior to enrollment and agree to continue the activity throughout study participation * Participant must live within approximately 1 hour of the study hospital, or live within 1 hour of adequate regional care, or be willing to remain in the hospital for at least five days post-procedure * Vaccinated for COVID-19, pneumococcus, and influenza (per European Union and Member State guidelines) or documented clinical intolerance or documented patient refusal * Cognitively able to provide written informed consent and willing to comply with study requirements * Severe emphysematous lung subsegments eligible for ETLA treatment Exclusion Criteria: * Body mass index (BMI) \< 16 kg/m\^2 or ≥ 33 kg/m\^2 * DLCO \< 20% predicted * Chronic bronchitis as defined by cough and sputum production for at least 3 months per year for two consecutive years, in the absence of other conditions that can explain these symptoms * 75ml or greater sputum production per day most days of the week * Greater than two hospitalizations for COPD exacerbations and/or pneumonia in the 12 months prior to enrollment * Diagnosis of asthma that is confirmed according to the Global Initiative for Asthma (GINA) guidelines * Prior lung volume reduction via endobronchial valves(s), coil(s), vapor and/or polymer. Patients whose valves have been removed \> 3 months previously can be treated if a baseline bronchoscopy reveals no airway obstruction or obvious tissue granulation and the reason for valve removal was not for complications e.g., Pneumonia, severe exacerbation, or pneumothorax. * Pulmonary hypertension * Alpha-1 antitrypsin deficiency * Uncontrolled diabetes mellitus * Prior heart or lung transplant * Myocardial infarction or stroke within the 12 months of enrollment * Diagnosis of heart failure * Heart failure requiring hospitalization, within 6 months prior to enrollment * History of bleeding disorders or enhanced predisposition to bleeding * History of severe/massive hemoptysis defined as \>200ml of blood loss in \< 24 hours * Unable to discontinue anti-coagulants or platelet inhibitors (acetylsalicylic acid \[ASA\]and non-ASA, including low dose) for at least 7 days prior to each procedure (or as per physician discretion based on the specific agent) and for at least 6 weeks after each procedure * Daily systemic steroids equivalent to \> 15mg prednisolone * Immunosuppressive drugs, such as for the treatment of cancer, autoimmune disease, or prevention of tissue/organ rejection * Pregnant, lactating, or women of childbearing potential that plan to become pregnant within the study duration * Currently enrolled in another trial studying an experimental treatment * Any disease or condition likely to limit survival to less than one year * Concomitant illnesses or medications that may pose a significant increased risk for complications following treatment with ETLA * Any condition that would interfere with evaluation or completion of the study including study assessments and procedures, including bronchoscopy. * Active aspergillus infection * Clinically significant bronchiectasis as determined by the Investigator * Radiological evidence of bronchiectasis in target region(s) and/or cystic radiological bronchiectasis in any region of the lungs * Clinically significant pulmonary fibrosis * Lung nodule not proven stable unless proven to have benign pathology * Large bulla (defined as \> 1/3 volume of a lung) * Prior Lung Volume Reduction Surgery (LVRS), bullectomy, or lobectomy * The remaining lung tissue NOT targeted for ETLA treatment is too highly diseased * Active respiratory infection or recent respiratory infection with resolution \< 4 weeks prior to screening or procedure * Recent COPD exacerbation within \< 6 weeks prior to screening or procedure