Aerosol Cyclosporine in Chronic Obstructive Pulmonary Disease (COPD)

Inclusion Criteria: * Age between 45 and 70 years. * A confirmed diagnosis of COPD, Gold Stage III, using current accepted diagnostic criteria, including clinical/laboratory findings, pulmonary function tests, and appropriate history to exclude other disorders that could explain their lung disease. * Subjects agree to maintain a stable medication regimen in the absence of a disease flare * ECOG performance status of 0, 1, or 2. * pCO2 \< 45 mm Hg, room air oxyhemoglobin saturation \> 85% * A willingness to participate in all portions of the protocol, including serial bronchoscopy, requisite surveillances, and ancillary immunologic studies in follow-up visits at this institution. * For woman of childbearing age, a negative pregnancy test, and a willingness to use two methods of contraception, or abstinence, and undergo monthly pregnancy testing. * Elevated T-cell cytokine gene expression, defined as baseline values \> the mean of the pilot Gold 0-1 study population for one variable (CD4+IL-2 \>23%, CD8+IFN-g \>17%, CD8+MHC \> 6%, or CD8 TGF-b). * An ability and willingness to provide written informed consent. Exclusion Criteria: * Three, or more exacerbations of lower respiratory disease in the past year requiring systemic corticosteroids, or one exacerbation requiring hospitalization in the past 6 months * Intubation for COPD, or other cause of respiratory failure in the past year * Use of immunosuppressive therapy (including oral prednisone), other than aerosolized corticosteroids, anytime within three months prior to participation * Evidence for an opportunistic infection/colonization of the airways, i.e., non-bacterial * Use of aerosolized corticosteroids with an inability to maintain inhaled corticosteroid therapy dosing without change during the study interval * Evidence for systemic illness including hematologic disorders (defined by an absolute neutrophil count (ANC) \< 4000 /mL and platelets \< 120,000/mL), renal insufficiency (serum creatinine \> 2.0 mg/dL), cirrhosis, or hepatic insufficiency (total bilirubin, or alkaline phosphatase \> 1.5 x normal, SGOT, or SGPT \> 1.2 x normal values), or a coagulopathy (INR \> 1.4), seizure disorder. * Evidence for systemic abnormal renal function manifested by uncontrolled hypertension (systolic blood pressure \> 160mmHg or diastolic blood pressure \>90mmHg), hyperkalemia (serum creatinine \> 5.0 meq/dl, and/or elevated serum creatinine above the normal range for the subject's age. * Evidence of coronary artery disease by history, e.g., angina or history of myocardial infarction within the past 12 months, unless corrected by CABG within \< 5 years, and asymptomatic since * Pregnant or breast feeding females or women of childbearing potential not practicing birth control during and for 6 months following treatment, or fertile and sexually active males unwilling to use contraceptive techniques during and for 6 months following treatment * Positive HIV, or hepatitis B or C serology, or another active infection * Current or past history of cancer excluding basal or squamous cell skin cancer * Undiagnosed pulmonary nodule requiring diagnostic evaluation * Weight loss \> 10% usual body weight over the past 6 months or a BMI \< 18 * Known hypersensitivity or allergy to propylene glycol, CsA, or lidocaine * Concurrent enrollment or participation within the prior month in other clinical trials * Greater than 15% or 200 ml reduction in FEV1 post test dose propylene glycol administration * Known medical or psychological condition (severe personality disorder or mental illness) that would not permit the subject to complete the trial or sign informed consent * Autoimmune disorders or other disorders with suspected systemic immune involvement * Active smoking history or urinary cotinine \> 2. * Hypersensitivity to midazolam or narcotics which would not allow bronchoscopy sedation