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Trial registered on ANZCTR
Registration number
ACTRN12611000674932
Ethics application status
Approved
Date submitted
29/04/2011
Date registered
4/07/2011
Date last updated
28/06/2018
Type of registration
Retrospectively registered
Titles & IDs
Public title
A randomised, cross-over trial of upright sitting versus alternate side lying during nebulised delivery of medication to improve the pattern of aerosol deposition in healthy participants
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Scientific title
A randomised, cross-over trial of upright sitting versus alternate side lying during nebulised delivery of medication to improve the pattern of aerosol deposition in healthy participants
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Secondary ID [1]
260082
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Nil
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Universal Trial Number (UTN)
U1111-1121-1087
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Trial acronym
Nil
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Healthy participants (to be compared to participants with cystic fibrosis of a similar age)
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Condition category
Condition code
Respiratory
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0
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Normal development and function of the respiratory system
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Human Genetics and Inherited Disorders
268351
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0
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Cystic fibrosis
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants will inhale 4mL technetium-99m DTPA radioaerosol in two positions in random order throughout the nebulisation period of 20 minutes for each of the positioning regimens on two separte days: 1. Upright sitting: or 2. Alternate Side Lying: (alternated between left and right at each minute)
The two study days will have a minimum of 48 hours washout between them and not greater than 7 days (to ensure clinical stability).
After each nebulisation a gamma camera will perform a 20 minute deposition scan incorporating a 2 minute transmission scan to outline the three-dimensional margin of the lung fields. This data will be reconstructed to determine the distribution of the deposited radioaerosol in the lungs.
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Intervention code [1]
264498
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Treatment: Other
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Intervention code [2]
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Treatment: Devices
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Comparator / control treatment
Upright sitting is the control condition, alternate side lying the experimental
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Control group
Active
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Outcomes
Primary outcome [1]
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The 3-dimensional map of the lung fields will be divided into unit volumes (voxels). The amount of radioactivity in each voxel will be calculated. The standard deviation of the radioactivity across all voxels within the margins of the lung fields will be used as an index of uniformity of the pattern of deposition for each participant.
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Assessment method [1]
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Timepoint [1]
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Immediately post 20 minutes of inhalation
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Secondary outcome [1]
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Proportion of the loaded dose (dose loaded in nebuliser - residual remining in nebuliser post 20 minutes of inhalation in MBq) delivered to the body (decay corrected gamma camera body image dose in MBq).
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Assessment method [1]
276157
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Timepoint [1]
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Immediately post 20 minutes of inhalation
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Secondary outcome [2]
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The proportion of the delivered dose (dose loaded in nebuliser - residual remining in nebuliser post 20 minutes of inhalation in MBq) that deposited in the lungs. (decay corrected lung gamma camera image dose in MBq).
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Assessment method [2]
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Timepoint [2]
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Immediately post 20 minutes of inhalation
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Secondary outcome [3]
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The concentration of the dose in the apical regions compared to the concentration for the whole lung. The 3-dimensional map of the lung fields will be divided into unit volumes (voxels). The amount of radioactivity in each voxel will be calculated. The ratio of apical:non-apical deposition of radioactivity will be determined by the mean number of counts per voxel in the apical one third of the lung field divided by the mean number of counts per voxel in the basal two thirds of the lung field.
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Assessment method [3]
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Timepoint [3]
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Immediately post 20 minutes of inhalation
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Eligibility
Key inclusion criteria
Inclusion Criteria: To participate in this study, a person must:
1 be 18 years of age or older
2 be able to read, write and comprehend English
3 have normal lung function, with greater than or equal to 80% predicted FEV1
4 be willing to inhale a 4mL radioaerosol and undergo a 20-minute gamma scan, on two occasions.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Exclusion Criteria: A person will be ineligible to participate in this study if s/he:
1 has any respiratory condition
2 has significant malignant, neurological or musculoskeletal conditions
3 is unable to perform spirometry reproducibly
4 is pregnant, or is sexually active and unwilling to use contraception during the study
5 is in a dependent relationship to any of the investigators, eg. student, junior staff.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Potential participants will be invited to read an Information for Participants document, and sign a consent form to participate in the study. Eligibility will then be confirmed with reference to the willing participant’s spirometry in standing according to the most recent American Thoracic Society criteria
Participants will then be randomised via a coin toss to one of:
1. Upright sitting: to be maintained throughout the nebulisation period of 20 minutes, or
2. Alternate Side Lying: to be alternated between left and right at each minute during the nebulisation period of 20 minutes.
Participants will be requested to adopt this position and maintain a normal tidal breathing pattern during the subsequent standard study inhalation. When participants return for their second study day, they will adopt the other positioning regimen.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Coin toss for first position
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
Coin toss for first of the two sidelying positions
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
3/03/2009
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Actual
20/04/2009
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Date of last participant enrolment
Anticipated
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Actual
25/06/2009
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Date of last data collection
Anticipated
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Actual
2/07/2009
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Sample size
Target
13
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Accrual to date
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Final
13
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Recruitment in Australia
Recruitment state(s)
NSW
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Australian CF Research Trust Post-Graduate Award.
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Address [1]
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P.O. Box 254
North Ryde NSW 1670
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Royal Prince Alfred Hospital
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Address
Level 3, Building 92 RPAH
Missenden Road
Camperdown NSW 2050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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SSWAHS (RPA Zone)
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Ethics committee address [1]
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Level 3 Building 92 RPAH Missenden Road Camperdown NSW 2050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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Approval date [1]
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03/03/2009
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Ethics approval number [1]
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Protocol No X09-0017 & HREC/09/RPAH/25
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Summary
Brief summary
Participants will inhale a 4mL radioaerosol in two positions in random order throughout the nebulisation period of 20 minutes: 1. Upright sitting: or 2. Alternate Side Lying: (alternated between left and right at each minute) After each nebulisation a gamma camera will perform a 20-minute deposition scan incorporating a 2-minute transmission scan to outline the three-dimensional margin of the lung fields. This data will be reconstructed to determine the distribution of the deposited radioaerosol in the lungs. A 15% improvement in uniformity of deposition is the proposed minimum difference that would make further investigation of the alternate side lying strategy worthwhile in patient populations. Significance of project: In many patient populations (eg, cystic fibrosis, HIV and bronchiectasis), the pattern of deposition of inhaled medication is poor and non-uniform. Typically the upper lobes receive a reduced dose compared to the rest of the lung. The ability to deliver a drug more uniformly to the lung using a strategy of side lying may have a significant impact on treatment efficacy for people with lung disease. Data from healthy participants will aid interpretation of subsequent studies in patients.
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Trial website
Nil
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Trial related presentations / publications
Nil
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Public notes
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Contacts
Principal investigator
Name
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Dr Ruth Dentice
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Address
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Department of Respiratory Medicine Level 11 Royal Prince Alfred Hospital Missenden Road Camperdown NSW 2050
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Country
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Australia
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Phone
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61 2 95155234
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Ruth Dentice
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Address
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Department of Respiratory Medicine Level 11
Royal Prince Alfred Hospital
Missenden Road Camperdown NSW 2050
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Country
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Australia
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Phone
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61 2 95155234
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Fax
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61 2 95158196
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Email
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[email protected]
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Contact person for scientific queries
Name
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Ruth Dentice
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Address
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Department of Respiratory Medicine Level 11
Royal Prince Alfred Hospital
Missenden Road Camperdown NSW 2050
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Country
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Australia
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Phone
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61 2 95155234
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Fax
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61 2 95158196
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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