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Trial registered on ANZCTR
Registration number
ACTRN12615000079549
Ethics application status
Approved
Date submitted
9/01/2015
Date registered
30/01/2015
Date last updated
30/01/2015
Type of registration
Retrospectively registered
Titles & IDs
Public title
Early detection of lung disease in smokers with normal spirometry
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Scientific title
Multiple breath nitrogen washout (MBNW) and impulse oscillometry system (IOS) to detect small airway disease in smokers with normal spirometry
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Secondary ID [1]
285935
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Nil
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Universal Trial Number (UTN)
U1111-1165-8083
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Chronic Obstructive Pulmonary Disease
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Condition category
Condition code
Respiratory
294166
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0
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Chronic obstructive pulmonary disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
There will be one (1) visit for this study which will either take place at the Woolcock Institute of Medical Research or at the Respiratory Investigation Unit at Royal North Shore Hospital. The visit will last around 90 minutes. All tests that we will administer are used routinely for lung function testing in hospital lung function laboratories in Australia and internationally.
We will perform an allergy test called a skin prick test. A small droplet of allergen will be placed on subject's forearm and the skin will be pricked lightly through the droplet. If subject is allergic to any of the allergens you will develop a small itchy lump, like a mosquito bite.
Subject's lung size will be measured in a body plethysmograph. This requires sitting in a clear Perspex booth during which subject will be asked to breathe on a mouth piece.Subject will be asked to breathe at different speeds and to take in a slow deep breath and then breathe out slowly and push all the air out of your lungs. The whole test will take approximately 15 minutes.
Two types of simple breathing tests will be conducted to measure how efficient subject's lungs are at moving air in and out. For the first test, known as spirometry, subject will be asked to take a deep breath and blow as hard and fast as you can for as long as you can into the mouthpiece. This manoeuvre will be repeated three times, and will take five minutes. For the second test, subject will be asked to breathe quietly on a mouthpiece for one minute while wearing a nose clip. Subject will feel a slight “flutter” in the air that he will breathe during this test, but it will not cause any discomfort.
A washout test will tell us how evenly air is distributed throughout the lungs. Subject will breathe into a mouthpiece, keeping the size of your breaths within a set range. During the test you will first breathe normal room air and then 100% oxygen for approximately 20 breaths. Each test is performed 3 times and it takes about 20-25 minutes to complete all three tests.
All the measurements will be made before and 20 minutes after inhalation of 200microgram of salbutamol (2 puffs) and 80 microgram of ipratropium bromide (4 puffs) via metered dose inhaler and large volume spacer in smokers with normal spirometry.
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Intervention code [1]
290911
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Early detection / Screening
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Comparator / control treatment
Spirometry, body plethysmography, single-breath diffusing capacity for carbon monoxide (DLCO), MBNW and IOS measurements will be made before and 20 minutes after inhalation of 200microgram of salbutamol and 80 microgram of ipratropium bromide via metered dose inhaler and large volume spacer in never smokers with normal spirometry.
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Control group
Active
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Outcomes
Primary outcome [1]
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Calculate the sensitivity and specificity of impulse oscillometry technique (IOS) and multiple breath nitrogen washout technique (MBNW) in detection of smoking induced peripheral airway altercation in smokers with normal spirometry
The reference values for IOS will be those of Newbury et al and values for spirometry will be those of Quanjer et al. We will use receiver operator curve (ROC) analysis to determine the specificity and sensitivity for IOS parameters to detect small airways disease, defined as abnormal Sacin or Scond. We will also compare the proportions of subjects who have abnormal values for IOS and MBNW using chi-square analyses. Relationships with smoking history will be examined using correlation analyses.
non smokers will not be included in this analaysis
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Assessment method [1]
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Timepoint [1]
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The outcome will be measured after all the data has been collected for smokers with normal spirometry.
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Secondary outcome [1]
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To determine whether abnormalities in Sacin and Scond (measured using MBNW) and resistance and reactance (measured using IOS) in smokers with normal spirometry were normalised by inhalation of short acting beta agonist and anti-cholinergic.
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Assessment method [1]
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Timepoint [1]
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The response will be measured after acute administration of bronchodilator (after 20 minutes of administration).
The improvement in Sacin and Scond and resistance and reactance in smokers will be compared against non smokers. Bronchodilator response and differences between groups were examined using t-tests, Mann–Whitney-U tests or Kruskal-Wallis and post hoc Dunn-Bonferroni tests as appropriate. Correlations were examined using Spearman correlation coefficients.
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Eligibility
Key inclusion criteria
Smokers with greater than equal to 10 Pack years of smoking history and Normal spirometry defined as FEV1> 80% predicted and FEV1/FVC greater than 0.70
Non smokers with Normal spirometry defined as FEV1> 80% predicted and FEV1/FVC greater than 0.70
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Minimum age
18
Years
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Maximum age
65
Years
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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
Any history of respiratory disease or cardiovascular disease.
Women who are pregnant
People who are unable to understand the patient information statement
Same criteria for never smokers will be included
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Study design
Purpose of the study
Diagnosis
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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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
1/05/2012
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Actual
21/05/2012
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Date of last participant enrolment
Anticipated
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Actual
20/09/2013
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
100
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
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Royal North Shore Hospital - St Leonards
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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GlaxoSmithKline
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Address [1]
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Level 4, 436 Johnston Street, Abbotsford, Victoria, 3067, Australia
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Kanika Jetmalani
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Address
Woolcock Institute of Medical Research
431 Glebe point Road, Glebe, NSW, 2037
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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A/Prof. Gregory King
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Address [1]
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Woolcock Institute of Medical Research
431 Glebe point Road, Glebe, NSW, 2037
Department of Respiratory Medicine
Royal North Shore Hospital
Pacific Highway
St Leonards, NSW, 2065
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Country [1]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Northern Sydney Central Coast Area Health Service Human Research Ethics Committee
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Ethics committee address [1]
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Research Office Royal North Shore Hospital St. Leonards, NSW, 2065
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
292169
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Approval date [1]
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28/11/2011
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Ethics approval number [1]
292169
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Summary
Brief summary
In chronic obstructive pulmonary disease (COPD), commonly associated with long term smoking, the earliest abnormality occurs in the very small airways. However, these changes to the small airways are unable to be detected by common lung function tests used in clinical practice and therefore early detection of COPD at present is impossible. In our laboratory we have two easy-to-perform lung function tests that are sensitive to abnormalities in the small airways and we want to determine whether these tests are able to detect abnormalities when common lung function tests remain normal and if they can be treated with administration of bronchodilators. If either of these tests are sensitive to small airway abnormalities it will mean that they have the potential to be used for the early detection of COPD in smokers. We hypothesise that IOS parameters will be sensitive to alterations in small airway function, as defined by abnormal ventilation heterogeneity measured by MBNW, in smokers with normal spirometry. Also, these abnormalities may be partially of completely reversed with bronchodilators.
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Trial website
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Trial related presentations / publications
1. K Jetmalani, A Bertolin, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2014), Can impulse oscillometry detect peripheral airway abnormalities measured using multiple breath nitrogen washout (MBNW) in asymptomatic smokers? Am J Respir Crit Care Med. 189 (meeting abstracts), P: A3547. 2. K Jetmalani, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2014), Is increased bronchomotor tone an important driving factor in developing acinar airway abnormalities in smokers with normal spirometry? Respirology. 19 suppl. 2. P: 2-6. 3. K Jetmalani, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2013), Small airway function in smokers with normal spirometry improves with bronchodilator. Am J Respir Crit Care Med. 187 (meeting abstracts), P: A1934. 4. K Jetmalani, D Chapman, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2013), Role of bronchomotor tone in developing acinar airway abnormalities in smokers with normal spirometry. Proceedings of XIIIth Annual Bosch Young Investigator Symposium. P: 21 5. K Jetmalani, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2013), Abnormal airway function in smokers with normal spirometry. Respirology. 18 suppl. 2. P: 4. 6. K Jetmalani, CS Farah, NJ Brown, N Berend, CM Salome, GG King (2013), Small airway function in smokers with normal spirometry improves with bronchodilator. Respirology. 18 suppl. 2. P: 20.
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Public notes
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Contacts
Principal investigator
Name
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Miss Kanika Jetmalani
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Address
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Woolcock Institute of Medical Research
431 Glebe Point Road, Glebe
NSW 2037
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Country
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Australia
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Phone
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+61291140147
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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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Kanika Jetmalani
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Address
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Woolcock Institute of Medical Research
431 Glebe point Road, Glebe, NSW, 2037
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Country
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Australia
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Phone
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+61291140147
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Fax
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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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Kanika Jetmalani
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Address
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Woolcock Institute of Medical Research
431 Glebe point Road, Glebe, NSW, 2037
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Country
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Australia
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Phone
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+61291140147
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Fax
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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
Source
Title
Year of Publication
DOI
Embase
Bronchodilator responsiveness of peripheral airways in smokers with normal spirometry.
2016
https://dx.doi.org/10.1111/resp.12802
N.B. These documents automatically identified may not have been verified by the study sponsor.
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