AeriSeal System in Patients With Advanced Upper Lobe Predominant Emphysema and Collateral Ventilation

Inclusion Criteria: * Willing and able to provide informed consent and to participate in the study * Diagnosis of advanced emphysema (GOLD Stage III or Stage IV disease) * Radiologic evidence of non-bullous upper lobe predominant heterogeneous emphysema with at least 2 target sites deemed appropriate for treatment evident by CT imaging * DLco between 20 and 60% predicted * Positive Collateral Ventilation as determined by the Chartis® System * Clinically significant dyspnea (defined as a MRC dyspnea score of 2 or greater at Screening) * Failure of standard medical therapy to provide adequate relief of symptoms (defined as regular use of standard medication for more than 1 month prior to Screening; standard medications include at least an inhaled beta agonist and inhaled anticholinergic unless medically contraindicated or prior medical failure) * Significant airflow obstruction as demonstrated by Spirometry 15 minutes after administration of bronchodilator with: * 5% \< FEV1 \< 50% predicted using the ATS recommended calculation for expected value * FEV1/FVC ratio \<70% * Physiological evidence of hyperinflation with Lung volumes (plethysmographic) of: * TLC \> 100% predicted using the ATS recommended calculation for expected value * RV \> 135% predicted using the ATS recommended calculation for expected value * Six-Minute Walk Test distance ≥ 150 m * Abstinence from inhaled tobacco use for at least 16 weeks prior to the initial Screening visit until the end of the study * Female patients are either post-menopausal or surgically sterile. Women with child-bearing potential will not be included in this study Exclusion Criteria: * Alpha-1 antitrypsin serum level of \< 80 mg/dL (i.e. \< 11 micro mol/L) at Screening * Body mass index \< 15 kg/m2 or \> 35 kg/m * Clinically significant asthma, chronic bronchitis or bronchiectasis as determined by the Investigator, or a significant COPD exacerbation within the past 4 months * Use of systemic steroids \> 20 mg/day or equivalent immunosuppressive agents, heparins, oral anticoagulants (e.g., warfarin, dicumarol; note: antiplatelet drugs including aspirin and clopidogrel are permitted) or investigational medications within 4 weeks of Screening * Allergy or sensitivity to medications required to safely perform AeriSeal System treatment under general anesthesia or conscious sedation * Participation in an investigational study of a drug, biologic, or device not currently approved for marketing within 30 days prior to the Screening visit * Prior lung volume reduction surgery, prior lobectomy or pneumonectomy, prior lung transplantation, prior airway stent placement, prior pleurodesis, or prior endobronchial lung volume reduction therapy of any type * Significant co-morbidity that carries prohibitive risks (e.g., HIV/AIDS, cancer) or is associated with less than 2-year expected survival * Blood gases and oxygen saturation: * SpO2 ≤ 90% on \> 4 L/min supplemental O2, at rest * PaCO2 ≥ 55mmHg * DLCO \< 20% or \> 60% predicted for patients with heterogeneous emphysema * Chest CT scan: Presence of any of the following radiologic abnormalities: * Pulmonary nodule on CT scan greater than 1.0 cm in diameter (Does not apply if present for 2 years or more without increase in size or if proven benign by biopsy/PET) * Giant Bullous Disease * Radiologic picture consistent with active pulmonary infection, e.g., unexplained parenchymal infiltrate * Significant interstitial lung disease (based upon investigator judgment) * Significant pleural disease (based upon investigator judgment) * Any condition that the Investigator believes would interfere with the intent of the study or would make participation not in the best interest of the patient