Not provided
Not provided
Not provided
Not provided
Not provided
Lower enrollment than Sponsor expected - Sponsor stopped study
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
This will be a non-blinded feasibility (pilot) study comparing triple therapy nebulizer vs dry powdered inhalers (DPI) for care transitions in Chronic obstructive pulmonary disease (COPD) exacerbation patients.
We hypothesize that patients treated in hospital and discharged on respiratory medications administered by nebulizers will exhibit better quality of life (QoL), symptom control, and lower COPD and all cause hospital readmission rates compared with patients treated with respiratory medications delivered by DPI.
We aim to demonstrate that:
Drugs used to treat Chronic obstructive pulmonary disease (COPD) are available primarily in hand held inhaler devices that deliver dry powder (DPI), a soft mist or a metered dose of spray (MDI). The frail, arthritic elderly are often prescribed DPI rather than MDI or soft mist devices, because they require less coordination. DPIs however require the ability to inhale against a resistance with a peak inspiratory force (PIF) more negative than 60 L/min to break the dry powder into respirable particles. Preliminary data suggests that suboptimal PIF's are common during an acute exacerbation of COPD, affecting 48% of hospitalized patients, thus placing them at risk for treatment failure and possibly hospital readmission. Use of nebulizers to administer respiratory medications may avoid the hazards of insufficient dosing that can result from use of DPI however they are cumbersome, expensive and the variety of drugs available in a nebulizer format is limited. We hypothesize that patients treated in hospital and is charged on respiratory medications administered by nebulizers will exhibit better symptom control and lower COPD and all cause hospital readmission rates compared with patients treated with respiratory medications delivered by DPI. We aim to demonstrate that 1) patients treated and discharged on nebulized bronchodilators will have fewer readmissions to hospital at 30 and 90 days compared to the group utilizing DPI 2) that the nebulizer group will demonstrate a longer duration of time till hospital readmission for COPD and all cause readmission compared to the group utilizing DPI and 3) the nebulizer group will demonstrate better symptom control compared to the group utilizing DPI. This nonblinded feasibility (pilot) study will enroll 100 patients hospitalized for an exacerbation of COPD who are > 40 years of age, have a clinical diagnosis of COPD. The study will consist of 3 outpatient visits (Transitional Care Visit [314 days after discharge], Visit #2 [30 +/5 days after discharge], and Visit #3 [90 +/5 days after discharge]). Visit #2 and #3 are for study purposes, the Transitional Care Visit is standard of care. We hypothesize and aim to demonstrate that patients treated in hospital and discharged on respiratory medications administered by nebulizers will exhibit better quality of life (QoL), symptom control and lower COPD and all cause hospital readmission rates compared with patients treated with respiratory medications delivered by DPI.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Nebulizers | Experimental | Subjects will receive a long-acting B2-agonist (LABA; Brovana, twice daily), corticosteroid (ICS; Pulmicort, twice daily), and a short-acting anti-cholinergic (SAMA; Atrovent, three times a day). |
|
| Dry Powder Inhaler | Experimental | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) plus a long-acting anticholinergic (LAMA; Spiriva Handihaler, once daily). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Nebulizers | Device | Patients treated and discharged on nebulized bronchodilators |
|
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Life Measured by St. George's Respiratory Questionnaire (SGRQ) | Scores range from 0 to 100, with higher scores indicating more limitations - Symptoms component (frequency & severity) with a 1, 3 or 12-month recall (best performance with 3- and 12-month recall); Part 2: Activities that cause or are limited by breathlessness; Impact components (social functioning, psychological disturbances resulting from airways disease) refer to current state as the recall | 90 Days |
| Measure | Description | Time Frame |
|---|---|---|
| Symptom Control Measured by the COPD Assessment Test (CAT) | The COPD Assessment Test (CAT) is a patient-completed instrument that can quantify the impact of COPD on the patient's health. The CAT is a validated, short (8-item) and simple patient completed questionnaire. The CAT has a scoring range of 0-40 and a difference or change of 2 or more units over 2 to 3 months in a patient suggests a clinically significant difference or change in health status. A score of >30 indicates that COPD has a very high impact on daily life, a score of >20 indicates a high impact, 10-20 is medium impact, <10 is low impact, and 5 is the upper limit for healthy non-smokers. A higher score would represent a poor outcome for this test. |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Pregnancy; subjects will be excluded if female and are not post-menopausal for at least one year. Since there is no possible benefit from participating in this protocol for a pregnant woman, we will exclude pregnant women. If a subject is found to be pregnant during the 90-day study period, they will be excluded from the study and their data not used for study purposes.
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Jill A Ohar, MD, FCCP | Professor of Internal Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Wake Forest Baptist Health | Winston-Salem | North Carolina | 27104 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23169314 | Background | Centers for Disease Control and Prevention (CDC). Chronic obstructive pulmonary disease among adults--United States, 2011. MMWR Morb Mortal Wkly Rep. 2012 Nov 23;61(46):938-43. | |
| 11463370 | Background | Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care. 2001 Aug;46(8):798-825. No abstract available. |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| FG000 | Nebulizers | Subjects will receive a long-acting B2-agonist (LABA; Brovana, twice daily), corticosteroid (ICS; Pulmicort, twice daily), and a short-acting anti-cholinergic (SAMA; Atrovent, three times a day). Nebulizers: Patients treated and discharged on nebulized bronchodilators Brovana: Subjects will receive a long-acting B2-agonist(LABA; Brovana, twice daily) Pulmicort: Subjects will receive a corticosteroid (ICS; Pulmicort, twice daily) Atrovent: Subjects will receive a short-acting anti-cholinergic (SAMA; Atrovent, three times a day) |
| FG001 | Dry Powder Inhaler | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) plus a long-acting anticholinergic (LAMA; Spiriva Handihaler, once daily). Dry Powder Inhaler: Patients treated and discharged on Dry Powder Inhalers Advair Diskus: Subjects will receive a LABA/ICS (Advair Diskus, twice daily) Spiriva HandiHaler: Subjects will receive a long-acting anticholinergic (LAMA-Spiriva Handihaler, once daily) |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | Nebulizers | Subjects will receive a long-acting B2-agonist (LABA; Brovana, twice daily), corticosteroid (ICS; Pulmicort, twice daily), and a short-acting anti-cholinergic (SAMA; Atrovent, three times a day). Nebulizers: Patients treated and discharged on nebulized bronchodilators Brovana: Subjects will receive a long-acting B2-agonist(LABA; Brovana, twice daily) Pulmicort: Subjects will receive a corticosteroid (ICS; Pulmicort, twice daily) Atrovent: Subjects will receive a short-acting anti-cholinergic (SAMA; Atrovent, three times a day) |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Quality of Life Measured by St. George's Respiratory Questionnaire (SGRQ) | Scores range from 0 to 100, with higher scores indicating more limitations - Symptoms component (frequency & severity) with a 1, 3 or 12-month recall (best performance with 3- and 12-month recall); Part 2: Activities that cause or are limited by breathlessness; Impact components (social functioning, psychological disturbances resulting from airways disease) refer to current state as the recall | Posted | Mean | Standard Deviation | score on a scale | 90 Days |
|
90 days
Not provided
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Nebulizers | Subjects will receive a long-acting B2-agonist (LABA; Brovana, twice daily), corticosteroid (ICS; Pulmicort, twice daily), and a short-acting anti-cholinergic (SAMA; Atrovent, three times a day). Nebulizers: Patients treated and discharged on nebulized bronchodilators Brovana: Subjects will receive a long-acting B2-agonist(LABA; Brovana, twice daily) Pulmicort: Subjects will receive a corticosteroid (ICS; Pulmicort, twice daily) Atrovent: Subjects will receive a short-acting anti-cholinergic (SAMA; Atrovent, three times a day) |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospitalizations | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | Hospitalizations |
Not provided
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Jill Ohar, MD | Wake Forest Health Science | 336-716-1210 | johar@wakehealth.edu |
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Mar 14, 2018 | Apr 5, 2021 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jan 8, 2020 | Oct 27, 2020 | ICF_000.pdf |
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D029424 | Pulmonary Disease, Chronic Obstructive |
| ID | Term |
|---|---|
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D002908 | Chronic Disease |
Not provided
Not provided
| ID | Term |
|---|---|
| D009330 | Nebulizers and Vaporizers |
| D058995 | Dry Powder Inhalers |
| D000068759 | Formoterol Fumarate |
| D019819 | Budesonide |
| D009241 | Ipratropium |
| D000068297 | Fluticasone-Salmeterol Drug Combination |
| ID | Term |
|---|---|
| D004864 | Equipment and Supplies |
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Dry Powder Inhaler | Device | Patients treated and discharged on Dry Powder Inhalers |
|
|
| Brovana | Drug | Subjects will receive a long-acting B2-agonist(LABA; Brovana, twice daily) |
|
|
| Pulmicort | Drug | Subjects will receive a corticosteroid (ICS; Pulmicort, twice daily) |
|
|
| Atrovent | Drug | Subjects will receive a short-acting anti-cholinergic (SAMA; Atrovent, three times a day) |
|
|
| Advair Diskus | Drug | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) |
|
|
| Spiriva HandiHaler | Drug | Subjects will receive a long-acting anticholinergic (LAMA-Spiriva Handihaler, once daily) |
|
|
| 90 Days |
| Symptom Control Measured by The Modified Medical Research Council Dyspnea Scale (mMRC) | The Modified Medical Research Council Dyspnea Scale, or MMRC, uses a simple grading system to assess a patient's level of dyspnea -- shortness of breath. The scale goes from 0-4 with a 0 = I only get breathless with strenuous exercise, 1 = I get short of breath when hurrying on level ground or walking up a slight hill, 2 = On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace, 3 = I stop for breath after walking about 100 yards or after a few minutes on level ground, and 4 = I am too breathless to leave the house or I am breathless when dressing. 4 would represent the worst outcome. | 90 Days |
| COPD and All-Cause Hospital Readmissions After 30 Days | Compare the number of hospital readmissions between the two arms after 30 days of using each device. | 30 Days |
| COPD and All-Cause Hospital Readmissions After 90 Days | Compare the number of hospital readmissions between the two arms after 90 days of using each device. | 90 Days |
| Unscheduled Clinic or ER Visits | Compare the number of unscheduled clinic or ER visits between the two arms after 90 days of using each device | 90 Days |
| Change in Pulmonary Inspiratory Force (PIF) From Baseline at 90 Days - R -2 (Low to Medium Resistance Inhalers) | Pulmonary inspiratory force (PIF) from hospital baseline between the two arms for the duration of the 90 day study. | Baseline and 90 days |
| Number of Deaths | 90 days |
| Change in Pulmonary Inspiratory Force (PIF) From Baseline at 90 Days - R -5 (High Resistance Inhalers) | Pulmonary inspiratory force (PIF) from hospital baseline between the two arms for the duration of the 90 day study. | Baseline and 90 days |
| 24152212 | Background | Pleasants RA, Ohar JA, Croft JB, Liu Y, Kraft M, Mannino DM, Donohue JF, Herrick HL. Chronic obstructive pulmonary disease and asthma-patient characteristics and health impairment. COPD. 2014 Jun;11(3):256-66. doi: 10.3109/15412555.2013.840571. Epub 2013 Oct 23. |
| 23818799 | Background | Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res. 2013 Jun 17;5:235-45. doi: 10.2147/CEOR.S34321. Print 2013. |
| 18836213 | Background | Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge S, Decramer M; UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008 Oct 9;359(15):1543-54. doi: 10.1056/NEJMoa0805800. Epub 2008 Oct 5. |
| 19716960 | Background | Calverley PM, Rabe KF, Goehring UM, Kristiansen S, Fabbri LM, Martinez FJ; M2-124 and M2-125 study groups. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials. Lancet. 2009 Aug 29;374(9691):685-94. doi: 10.1016/S0140-6736(09)61255-1. |
| 18614347 | Background | Ferguson GT, Anzueto A, Fei R, Emmett A, Knobil K, Kalberg C. Effect of fluticasone propionate/salmeterol (250/50 microg) or salmeterol (50 microg) on COPD exacerbations. Respir Med. 2008 Aug;102(8):1099-108. doi: 10.1016/j.rmed.2008.04.019. Epub 2008 Jul 9. |
| 24429127 | Background | Dransfield MT, Bourbeau J, Jones PW, Hanania NA, Mahler DA, Vestbo J, Wachtel A, Martinez FJ, Barnhart F, Sanford L, Lettis S, Crim C, Calverley PM. Once-daily inhaled fluticasone furoate and vilanterol versus vilanterol only for prevention of exacerbations of COPD: two replicate double-blind, parallel-group, randomised controlled trials. Lancet Respir Med. 2013 May;1(3):210-23. doi: 10.1016/S2213-2600(13)70040-7. Epub 2013 Apr 12. |
| 22611179 | Background | Cazzola M, Page CP, Calzetta L, Matera MG. Pharmacology and therapeutics of bronchodilators. Pharmacol Rev. 2012 Jul;64(3):450-504. doi: 10.1124/pr.111.004580. Epub 2012 May 18. |
| 20381630 | Background | Cazzola M, Molimard M. The scientific rationale for combining long-acting beta2-agonists and muscarinic antagonists in COPD. Pulm Pharmacol Ther. 2010 Aug;23(4):257-67. doi: 10.1016/j.pupt.2010.03.003. Epub 2010 Apr 8. |
| 23025451 | Background | Mahler DA, Waterman LA, Gifford AH. Prevalence and COPD phenotype for a suboptimal peak inspiratory flow rate against the simulated resistance of the Diskus(R) dry powder inhaler. J Aerosol Med Pulm Drug Deliv. 2013 Jun;26(3):174-9. doi: 10.1089/jamp.2012.0987. Epub 2012 Oct 1. |
| Background | Loh CH, Lovings T, Ohar JA . Low Inspiratory Flow Rates Predict COPD and All Cause Readmissions. ATS Abstract;2016;In press |
| BG001 | Dry Powder Inhaler | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) plus a long-acting anticholinergic (LAMA; Spiriva Handihaler, once daily). Dry Powder Inhaler: Patients treated and discharged on Dry Powder Inhalers Advair Diskus: Subjects will receive a LABA/ICS (Advair Diskus, twice daily) Spiriva HandiHaler: Subjects will receive a long-acting anticholinergic (LAMA-Spiriva Handihaler, once daily) |
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Inter-Quartile Range | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| BMI | Mean | Inter-Quartile Range | kg/m2 |
|
| OG001 | Dry Powder Inhaler | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) plus a long-acting anticholinergic (LAMA; Spiriva Handihaler, once daily). Dry Powder Inhaler: Patients treated and discharged on Dry Powder Inhalers Advair Diskus: Subjects will receive a LABA/ICS (Advair Diskus, twice daily) Spiriva HandiHaler: Subjects will receive a long-acting anticholinergic (LAMA-Spiriva Handihaler, once daily) |
|
|
| Secondary | Symptom Control Measured by the COPD Assessment Test (CAT) | The COPD Assessment Test (CAT) is a patient-completed instrument that can quantify the impact of COPD on the patient's health. The CAT is a validated, short (8-item) and simple patient completed questionnaire. The CAT has a scoring range of 0-40 and a difference or change of 2 or more units over 2 to 3 months in a patient suggests a clinically significant difference or change in health status. A score of >30 indicates that COPD has a very high impact on daily life, a score of >20 indicates a high impact, 10-20 is medium impact, <10 is low impact, and 5 is the upper limit for healthy non-smokers. A higher score would represent a poor outcome for this test. | Posted | Mean | Standard Deviation | score on a scale | 90 Days |
|
|
|
| Secondary | Symptom Control Measured by The Modified Medical Research Council Dyspnea Scale (mMRC) | The Modified Medical Research Council Dyspnea Scale, or MMRC, uses a simple grading system to assess a patient's level of dyspnea -- shortness of breath. The scale goes from 0-4 with a 0 = I only get breathless with strenuous exercise, 1 = I get short of breath when hurrying on level ground or walking up a slight hill, 2 = On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace, 3 = I stop for breath after walking about 100 yards or after a few minutes on level ground, and 4 = I am too breathless to leave the house or I am breathless when dressing. 4 would represent the worst outcome. | Posted | Mean | Standard Deviation | score on a scale | 90 Days |
|
|
|
| Secondary | COPD and All-Cause Hospital Readmissions After 30 Days | Compare the number of hospital readmissions between the two arms after 30 days of using each device. | Posted | Number | number of readmissions | 30 Days |
|
|
|
| Secondary | COPD and All-Cause Hospital Readmissions After 90 Days | Compare the number of hospital readmissions between the two arms after 90 days of using each device. | Posted | Number | number of readmissions | 90 Days |
|
|
|
| Secondary | Unscheduled Clinic or ER Visits | Compare the number of unscheduled clinic or ER visits between the two arms after 90 days of using each device | Posted | Number | number of visits | 90 Days |
|
|
|
| Secondary | Change in Pulmonary Inspiratory Force (PIF) From Baseline at 90 Days - R -2 (Low to Medium Resistance Inhalers) | Pulmonary inspiratory force (PIF) from hospital baseline between the two arms for the duration of the 90 day study. | Posted | Mean | Standard Deviation | cmH2O | Baseline and 90 days |
|
|
|
| Secondary | Number of Deaths | Posted | Count of Participants | Participants | 90 days |
|
|
|
| Secondary | Change in Pulmonary Inspiratory Force (PIF) From Baseline at 90 Days - R -5 (High Resistance Inhalers) | Pulmonary inspiratory force (PIF) from hospital baseline between the two arms for the duration of the 90 day study. | Posted | Mean | Standard Deviation | cmH2O | Baseline and 90 days |
|
|
|
| 1 |
| 21 |
| 3 |
| 21 |
| 0 |
| 21 |
| EG001 | Dry Powder Inhaler | Subjects will receive a LABA/ICS (Advair Diskus, twice daily) plus a long-acting anticholinergic (LAMA; Spiriva Handihaler, once daily). Dry Powder Inhaler: Patients treated and discharged on Dry Powder Inhalers Advair Diskus: Subjects will receive a LABA/ICS (Advair Diskus, twice daily) Spiriva HandiHaler: Subjects will receive a long-acting anticholinergic (LAMA-Spiriva Handihaler, once daily) | 1 | 19 | 7 | 19 | 0 | 19 |
|
| Re-admissions into Hospital | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | Re-admissions into Hospital |
|
Not provided
Not provided
Not provided
| D020969 |
| Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009930 |
| Organic Chemicals |
| D000588 | Amines |
| D011282 | Pregnenediones |
| D011283 | Pregnenes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D001286 | Atropine Derivatives |
| D014326 | Tropanes |
| D053961 | Azabicyclo Compounds |
| D001372 | Aza Compounds |
| D001533 | Belladonna Alkaloids |
| D012991 | Solanaceous Alkaloids |
| D000470 | Alkaloids |
| D006571 | Heterocyclic Compounds |
| D019086 | Bridged Bicyclo Compounds, Heterocyclic |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D000068299 | Salmeterol Xinafoate |
| D000420 | Albuterol |
| D010627 | Phenethylamines |
| D005021 | Ethylamines |
| D000068298 | Fluticasone |
| D000730 | Androstadienes |
| D000736 | Androstenes |
| D000731 | Androstanes |
| D004338 | Drug Combinations |
| D004364 | Pharmaceutical Preparations |