The research team at MBR Health has recently published an observational case report in Frontiers in Medicine describing clinical and imaging findings in a patient with chronic obstructive pulmonary disease (COPD), severe emphysema lung-changes, and chronic hypersensitivity pneumonitis. The male patient in this case report was in his early 70s and received monthly-sessions of nebulised autologous platelet-rich plasma (PRP) of the course of eight months.
The novel findings of this case study described improvements in CT imaging of the lungs, airflow, patient-reported breathlessness and functional capacity over the treatment period. In this article, we explain what nebulised PRP is and what these findings mean.
What is nebulised PRP?
Platelet-rich plasma is prepared from an individual’s own (autologous) whole blood and contains concentrated platelets, growth factors and other biological factors which participate in anti-inflammatory, regenerative, and anti-microbial pathways.
PRP is considered a type of regenerative medicine and is commonly used in a range of clinical indications including use in dental, skin, surgical wound healing, sports injuries. At MBR Health, our specialist radiologist, Dr Zane Sherif, commonly performs image-guided PRP injections for osteoarthritis, back pain, and other common inflammatory or injury-related causes of pain.
Despite its biological plausibility, there is limited literature exploring the use of autologous PRP in respiratory disease, with even less evaluating its delivery via nebulisation. In our paper, the patient’s PRP was aerosolised and delivered into the airways using a nebuliser in accordance with the Sherif Pulmonary Protocol (1, 2).
What is an observational case report?
An observational case report describes what was observed in an individual patient during the course of their clinical care, rather than testing an intervention as part of a prospectively designed research study. In this case, the MBR Health research team reviewed lung imaging and functional assessments performed as part of the patient’s routine clinical follow-up for management of COPD and hypersensitivity pneumonitis. No additional procedure or treatment was performed for the purpose of research.
Case reports can be valuable for documenting new or unexpected clinical observations, particularly where there is limited existing evidence. While they cannot establish whether a treatment caused an observed outcome, they provide an important foundation for future research.
Reduction in emphysema-related changes on CT
Over the course of the observation period, the patient received eight nebulised PRP treatments, with one session every month for a total of eight months. Apart from one delayed treatment due to confirmed viral respiratory illness, the patient did not experience any adverse side effects attributed to treatment.
Following treatment, quantitative analysis of the CT scans demonstrated an 11.5% reduction in overall lung volume compared with baseline, with a 22% relative reduction in the proportion of lung tissue showing emphysema-related changes.
The reduction in lung volume may simply reflect that the patient took a shallower breath during the follow-up scan. However, it may also represent less air trapping or reduced hyperinflation. Abnormally increased lung volume, known as hyperinflation, is a common feature of COPD due to air trapping, causing the lungs to remain over-expanded.
These unexpected yet striking findings must be interpreted with cautious optimism. Emphysema measures on quantitative CT are sensitive to changes in lung inflation. Prior research has shown that reducing inspiration from 100% to 90% of vital capacity resulted in a 2% difference in the amount of quantifiable emphysema burden on CT. This suggests that the lower level of inspiration, or reduction in air trapping and hyperinflation, on our follow up scan may explain some, but not all, of the observed changes in the reduced emphysema burden. However, we cannot determine how much of the observed change can be attributed to these factors from this case report alone.
Importantly, there was no CT evidence of fibrosis or worsening of lung condition at baseline or follow-up.
Improvements in Peak Expiratory Flow (PEF) Measures
Changes were also observed in the patient’s lung function. Throughout the observation period, the patient self-initiated daily measurements of peak expiratory flow (PEF) at home twice each day. PEF measures how quickly air can be expelled from the lungs and provides an indication of expiratory airflow.
By the end of the observation period, average morning PEF had increased by approximately 20%, from 418 to 500 L/min, with a similar improvement seen in evening measurements.
Importantly, this improvement was also seen on formal lung function testing performed independently as part of the patient’s routine respiratory care. PEF also increased by approximately 20% from the most recent spirometry measures approximately five months prior to start of nebulised PRP treatment. Other standard measures of lung function, including FEV₁ and FVC, remained essentially unchanged from the patient’s most recent spirometry.
This finding is interesting in the context of COPD, where air trapping and reduced elastic recoil can make it more difficult to breathe air out. The improvement in PEF may indicate a change in expiratory airflow or airway mechanics during the observation period, although the cause cannot be determined from this case.
Not all physiological measures changed in a favourable direction. The lung’s measured capacity to transfer gas into the blood (DLCO) decreased at follow-up. The significance of this finding is uncertain and highlights the need for further investigation.
Patient-Reported Improvements in Symptoms and Functional Capacity
Before treatment, the patient reported needing to stop and rest after walking approximately 20 metres on level ground because of breathlessness. During treatment, the patient reporting being able to walk up to 460 metres on ground. At approximately eight-months of treatment, the patient invested in a treadmill to continue his self-prescribed exercise. At the time of publishing, he reported being able to walk up to 1,400 on the treadmill without needing to stop and rest.
The patient also reported less breathlessness with activity, reduced fatigue, improved energy and motivation, and improvement in his productive morning cough.
Scientific rigour requires these findings to be interpreted with caution. Due to the nature of this observational report, no formal functional or exercise testing was prescribed. As a result, the patient reported quantitative improvements in walking tolerance (e.g. 20 m to 1,400m), cannot be considered objective measures of improvement from baseline. Therefore, must be considered subjective reported-patient outcomes. The walking distances were also recorded under different conditions, ground vs treadmill, and therefore cannot be directly compared as a formal measure of improvement.
Nevertheless, the patient-reported changes occurred alongside the observed improvements in peak expiratory flow and quantitative CT findings, providing another clinical outcome that supports further investigation.
What do these findings mean?
COPD and emphysema are chronic, progressive conditions characterised by structural lung damage that is considered largely irreversible. Against this background, the improvements across CT imaging, airflow and functional capacity are particularly noteworthy.
However, because this was an observational case study of a single patient, the ability to conclude whether PRP caused these changes is limited. To our knowledge, this is the first report of nebulised PRP in an individual with COPD demonstrating concordant improvements across CT imaging, lung function, and patient reported outcomes. As such, these novel findings are worthy for further investigation in a larger, prospectively designed clinical trial. Further study regarding platelet dose, final composition of PRP delivered to the airways, optimal frequency, study represents an early clinical signal worthy of further investigation in larger, prospectively designed clinical studies.
Innovation often starts with n=1. The research team at MBR Health is proud to have contributed to an important first observation and taken the first step towards investigating this novel approach in chronic lung disease. We are excited to see where further research takes it.
Frequently Asked Questions
Below are some of our most commonly asked questions regarding our recent nebulised PRP case reports. Visit our FAQ page for more frequently asked questions.
Why is this case report important?
There is currently limited published research investigating autologous PRP in chronic lung disease, particularly when delivered by nebulisation. This case contributes an early clinical observation and provides a foundation for further prospective research.
Why deliver PRP through a nebuliser?
Nebulisation converts PRP into an aerosol that can be inhaled into the airways. This provides a method of delivering platelet-derived biological factors directly to the respiratory system. Prior feasibility research by Beitia and colleagues in 2021, found that aerosolised lysate retained similar biological activity compared to standard PRP lysate, suggesting that the regenerative effects may be preserved through nebulisation. However, further research is needed to confirm the final aerosolised product delivered to the airways.
What is the Sherif Pulmonary Protocol?
The Sherif Pulmonary Protocol is a structured approach developed by Dr Zane Sherif for delivering high-cell-count autologous platelet-rich plasma (PRP) to the lungs via nebulisation. PRP is prepared from the patient’s own blood and aerosolised using a nebuliser, allowing platelet-derived biological factors to be delivered directly to the airways and lungs. The protocol combines nebulised PRP with clinical assessment and Spectral CT imaging follow-up to objectively evaluate changes in the lungs over time. It remains an experimental approach, with ongoing research investigating its potential applications in pulmonary disease.
What is quantitative lung CT analysis?
Quantitative lung CT uses specialised software to objectively measure lung volume, density and emphysema-related changes on CT scans. It allows changes between scans to be measured numerically, rather than relying on visual assessment alone. Not all radiology providers offer quantitative CT for COPD. At MBR Health, our quantitative Spectral CT for COPD analysis may be performed with no-out of pocket costs with a valid Medicare eligible referral. If you are seeking a quantitative lung assessment, please contact the MBR Health reception team who are happy to answer your questions.
What was particularly interesting about the findings of this study?
Changes were observed across several different areas: quantitative CT imaging, peak expiratory flow, and patient-reported respiratory symptoms and functional capacity. The combination of these observations is what makes the case worthy of further investigation.
Is nebulised PRP a Treatment for COPD or other lung conditions?
While the findings of this observational case report are encouraging, nebulised PRP is currently an investigational approach and is not an established treatment for COPD. Further research is required to further elucidate the benefits (and risks) of nebulised PRP across COPD and other related lung conditions. Visit our Research and Innovation page to learn more about our regenerative medicine programmes.
Is nebulised PRP safe?
In the two published Sherif case reports to date, nebulised autologous PRP was well tolerated, with no treatment-related adverse events reported, including approximately 12 months of long term follow up of the female cancer patient. While these early findings are reassuring, larger prospective studies are required to establish the safety profile of nebulised PRP across a broader patient population.
Where can I read the research?
The full peer-reviewed case report, including the methodology, results, limitations and discussion, is available in Frontiers in Medicine – Respiratory Medicine, available online.
References
1. Sherif Z, Sherif K. Case Report: Nebulized platelet-rich plasma facilitates resolution of post-infective pulmonary consolidation and cavitation in a lung cancer survivor. Frontiers in Medicine. 2026;12:1738044. doi:10.3389/fmed.2025.1738044.
2 Sherif Z, Forbes A, Sherif K. Case Report: Nebulized autologous platelet-rich plasma associated with quantitative CT and clinical changes in a patient with COPD and chronic hypersensitivity pneumonitis. Frontiers in Medicine. 2026;13:1939351. doi:10.3389/fmed.2026.1939351.
Author: A. Forbes (PhD), Clinical Research and manuscript co-author at MBR Health
Last reviewed: 30 Sep 2026
