The company treating chronic bronchitis with a metered spray of -196°C liquid nitrogen - freezing the damage so the airway can heal itself.
Chronic bronchitis is one of medicine's stubborn conditions. Millions of people with COPD live with airways clogged by excess mucus and lined with damaged, cilia-worn tissue. For decades the standard answer has been the same: inhalers, steroids, and management of symptoms. CSA Medical, a modestly sized medical device company in Lexington, Massachusetts, took a different route - one that starts by making the airway very, very cold.
Its RejuvenAir System threads through a standard bronchoscope and delivers a precisely metered spray of liquid nitrogen onto the diseased lining of the airways. The cold destroys the damaged cilia and the mucus-producing goblet cells that drive chronic bronchitis. Crucially, it spares the extracellular matrix beneath - the biological scaffold the body uses to regrow a fresh, healthy layer of tissue. The company calls the result "airway rejuvenation." The clinical shorthand is airway remodeling. Either way, the ambition is the same: treat the cause, not just the cough.
A physician guides the RejuvenAir catheter into the airways through a standard bronchoscope. No incision, often outpatient.
A circumferential catheter delivers a dose-controlled cryospray of -196°C liquid nitrogen, tuned to airway diameter.
Rapid freezing kills the damaged cilia and mucus-producing goblet cells while preserving the tissue matrix underneath.
Healthy epithelial cells regrow on the preserved scaffold. No implant is left behind.
"The RejuvenAir System is designed to address the underlying cause of chronic bronchitis - the damaged cilia and mucus-producing goblet cells lining the airways - and enable a rejuvenative healing response."
- CSA Medical, describing the therapy's mechanismWhat it does. CSA Medical designs, builds, and sells spray cryotherapy systems - a capital console paired with single-use catheters. Its focus today is pulmonary: the RejuvenAir System for COPD patients with chronic bronchitis. The company's cryospray lineage began in the gastrointestinal tract with truFreeze, an endoscopic system cleared to ablate tissue in Barrett's esophagus that became the most widely used device of its kind with over 11,000 treatments before the GI business was divested to STERIS.
Who uses it. The direct customers are hospitals, interventional pulmonologists, and thoracic centers that perform bronchoscopy. The ultimate beneficiaries are COPD patients who have run out of good options. The pivotal SPRAY-CB trial enrolled 210 patients worldwide, and more than 500 Metered CryoSpray procedures have been performed to date.
The problem it solves. Chronic bronchitis has no device-based, disease-modifying therapy on the market. Patients cycle through medications that ease symptoms without addressing the mucus overproduction and airway damage at the root. RejuvenAir targets that root - and earned FDA Breakthrough Device Designation precisely because it addresses a large, underserved population.
The business model. It is a classic medtech razor-and-blade: sell or place the cryospray console, then generate recurring revenue from the disposable catheters used in each procedure. Growth is gated by regulatory approvals - a CE mark already secured in Europe, and a PMA filed with the FDA in January 2026 - and by adoption among pulmonologists.
Most COPD therapy manages symptoms. RejuvenAir targets the damaged cells and mucus machinery that produce them.
Unlike valves or coils, the cryospray leaves no implant. It works, then gets out of the body's way.
An energy-control algorithm and circumferential catheter tune the cryospray dose to each airway diameter.
The technology was refined for years in the esophagus before being re-engineered for the lungs.
Interventional pulmonology is a crowded but young field. The alternatives to RejuvenAir range from everyday pharmacology to competing device approaches. This is an illustrative view of how these options position on invasiveness versus how directly they target the underlying tissue - not a clinical ranking.
FDA label expansions cover low- and high-grade dysplasia; cryospray proves itself in the GI tract.
RejuvenAir Metered CryoSpray shows early promise in COPD patients with chronic bronchitis.
The company centers on the pulmonary program after divesting its GI cryotherapy business to STERIS.
SPRAY-CB finishes enrolling 210 patients ahead of schedule; an oversubscribed Series D closes.
Following positive SPRAY-CB results, CSA Medical files its Premarket Approval application with the FDA.
"First-of-its-kind, bronchoscopic, device-based therapy that targets diseased airway tissue in chronic bronchitis - with no implant left behind."
- How the company frames RejuvenAir's place in interventional pulmonologyThe company is led by president and CEO Wendelin Maners, who joined CSA Medical in 2011 as VP of Emerging Therapies after roles at Boston Scientific and in healthcare investment banking. The leadership bench pairs clinical, regulatory, quality, and commercial expertise - the mix a device company needs to move from a pivotal trial to a market launch.
CSA Medical develops spray cryotherapy medical devices. Its flagship product, the RejuvenAir System, delivers metered doses of -196°C liquid nitrogen through a bronchoscope to treat chronic bronchitis in COPD patients.
It sprays a controlled dose of liquid nitrogen onto damaged airway tissue, destroying diseased cilia and mucus-producing cells while preserving the extracellular matrix - which allows healthy airway cells to regrow.
As of January 2026, CSA Medical submitted a Premarket Approval (PMA) application to the FDA following positive pivotal SPRAY-CB trial results. It holds FDA Breakthrough Device Designation and a European CE mark, but full FDA approval was still pending review.
The company has raised roughly $161M in total, including an oversubscribed $53M Series D in September 2024 co-led by TVM Capital Life Science and Yonjin Ventures.
CSA Medical is headquartered at 131 Hartwell Avenue, Lexington, Massachusetts, and employs about 33 people.
Official channels, key coverage, and the clinical record behind the RejuvenAir System.