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Trial registered on ANZCTR
Registration number
ACTRN12616000112460p
Ethics application status
Submitted, not yet approved
Date submitted
21/01/2016
Date registered
2/02/2016
Date last updated
2/02/2016
Type of registration
Prospectively registered
Titles & IDs
Public title
The Fine Particle Aerosols in Uncontrolled Asthma Study: Efficacy of small aerosol versus large aerosol budesonide in the treatment of uncontrolled asthma in adults.
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Scientific title
The pivotal role of targeting treatment to the small airways in patients with uncontrolled asthma.
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Secondary ID [1]
288387
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None
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Universal Trial Number (UTN)
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Trial acronym
TFPAUAS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Asthma
297392
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Condition category
Condition code
Respiratory
297582
297582
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0
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Asthma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The run-in period of this study will involve participants taking 200ug/day budesonide (Pulmicort Turbuhaler) for 4 weeks.
This will be followed by a two arm interventional study period which involves administration of budesonide modified into either small or large aerosols, for the treatment of asthma.
For both arm 1 (small aerosols ~1um) and arm 2 (large aerosols ~5um) participants will take 800ug/day of the study drug for a period of 12 weeks.
Adherence throughout the run-in period and the study period will be monitored with daily peak flow diaries to record lung function, daily asthma control questionnaires, and fortnightly phone calls from the research team.
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Intervention code [1]
293692
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Treatment: Drugs
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Comparator / control treatment
Arm 2 (large aerosols ~5um)
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in small airway function (as Sacin) measured by multiple breath nitrogen washout (MBNW), with differences between groups to be compared by parametric or non-parametric comparisons as appropriate.
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Assessment method [1]
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Timepoint [1]
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Small airway function in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Secondary outcome [1]
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Differences in asthma control between the two groups. This outcome will be assessed by reviewing daily Asthma Control Questionnaires (ACQs).
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Assessment method [1]
320100
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Timepoint [1]
320100
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Asthma control in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Secondary outcome [2]
320101
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Differences in lung function (which can be assessed by one of more of the following: FEV1, FVC, FEV1/FVC ratio, PEF, FEF25-75, and FIVC) in the groups will be assessed by spirometry.
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Assessment method [2]
320101
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Timepoint [2]
320101
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Lung function (which can be assessed by one of more of the following: FEV1, FVC, FEV1/FVC ratio, PEF, FEF25-75, and FIVC) in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Secondary outcome [3]
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Relationships between changes in lung function (assessed by spirometry) and asthma control (assessed by daily ACQs).
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Assessment method [3]
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Timepoint [3]
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The relationships between changes in lung function and asthma control in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Secondary outcome [4]
320210
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Lung volumes (which can be assessed by one of more of the following: TLC, VC, FRC, RV, and RV/TLC ratio) in the two groups will be assessed by body plethysmography.
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Assessment method [4]
320210
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Timepoint [4]
320210
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Lung volumes (which can be assessed by one of more of the following: TLC, VC, FRC, RV, and RV/TLC ratio) in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Secondary outcome [5]
320211
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Diffusion capacity of the lung in the two groups will be assessed by Diffusing Capacity of Lung for Carbon Monoxide (DLCO).
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Assessment method [5]
320211
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Timepoint [5]
320211
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Diffusion capacity of the lung (DLCO) in the two groups will be assessed at baseline following the run-in period, and at 12 weeks post commencement of the intervention.
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Eligibility
Key inclusion criteria
1. Current asthma defined as having a doctor diagnosis of asthma and asthma symptoms and asthma medication use in the last 12 months.
2. Be taking less than 400 ug of budesonide daily or alternative, with or without LABA.
3. Currently clinically stable.
4. Asthma Control Questionnaire (ACQ) score of >1.
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Minimum age
18
Years
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Maximum age
45
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Current smoker (at least 1 cigarette/day >3 months) within the previous 12 months, or having past smoking history of >10 pack/years.
2. Had an asthma exacerbation (defined as an increase in asthma symptoms for >2 days requiring an increase in inhaled corticosteroid (ICS) treatment or administration of prednisone, within the last 6 weeks.
3. Admission to a hospital ward for 1 night or more for asthma, in the last 12 months.
4. Unable to provide written, informed consent.
5. Have significant co-existent pulmonary or cardiac disease that could, in the opinion of the Chief Investigators, affect small airway function and/or modify respiratory symptoms. These include but are not limited to emphysema, pulmonary fibrosis, pulmonary hypertension, bronchiectasis and heart failure.
6. Inability to satisfactorily use a pMDI after education on pMDI technique.
7. Taking >800ug budesonide equivalent.
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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)
Both research staff and participants will be blinded to the identity of the small or large particle pressurised metered dose inhalers (pMDI’s). After production, the pMDIs will be blinded by Young and Traini and marked only as ‘Puffer A’ or ‘Puffer B’ and these will be stored in the Woolcock Institute of Medical Research Pharmacy. A person who is independent of the study (staff of the Airway Physiology and Imaging Group of The Woolcock Institute of Medical Research) will maintain the study code, in the unlikely event that the study code needs to be broken.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
15/02/2016
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Actual
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Date of last participant enrolment
Anticipated
30/09/2018
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
120
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,VIC
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Recruitment hospital [1]
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Royal North Shore Hospital - St Leonards
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Recruitment hospital [2]
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Concord Repatriation Hospital - Concord
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Recruitment hospital [3]
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The Alfred - Prahran
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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NH&MRC
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Address [1]
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Level 1
16 Marcus Clarke Street
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Other
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Name
Woolcock Institute of Medical Research
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Address
431 Glebe Point Rd
Glebe NSW 2037
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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]
291472
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Country [1]
291472
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
294227
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Northern Sydney Local Health District Human Research Ethics Committee
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Ethics committee address [1]
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Level 13, Kolling Building Royal North Shore Hospital Reserve Rd St Leonards NSW 2065
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Ethics committee country [1]
294227
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Australia
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Date submitted for ethics approval [1]
294227
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30/11/2015
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Approval date [1]
294227
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Ethics approval number [1]
294227
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Summary
Brief summary
Asthma affects approximately 1:10 adults and 1:5 children. Although most subjects attained good control of their asthma with conventional treatment, there is a significant proportion who are resistant to conventional treatment and remain uncontrolled. Although there are several mechanisms that may explain incomplete asthma control, one important factor which is potentially easy to address, is the presence of severe small airways disease that is not effectively improved by inhaled corticosteroid treatment. The small airways are an important determinant of asthma control and severity. They are airways with an internal diameter of 2 mm or less and because of the branching nature of the airway tree, occupy a very large surface area compared to the larger and more proximal airways. We have recently shown that small airway function improves with high dose inhaled corticosteroid treatment in parallel with improving asthma control. Furthermore, asthma control and severity are strongly related to small airways function. It therefore follows that persisting small airways disease is an important determinant of severe asthma and that better treatment of the small airways will improve the treatment of severe asthma. The obvious problem with treating small airways that are severely affected by inflammation and tissue remodelling, is that it is difficult to deposit therapeutic aerosols there. This is because ventilation to those airways is poor, because of severe airway narrowing and closure. Therapeutic aerosols require ventilation to carry them to the target sites and so the worst affected airways receive less of the inhaled aerosols. There is a theoretical advantage of using fine particle aerosols, because they are more likely to be carried to areas where ventilation is poor. Particles greater than 3 – 5 um deposit in the medium to large airways, while smaller particles will be carried into smaller and narrowed airways. Therefore, we propose that small particle aerosols will be more effective in uncontrolled asthma than larger particle aerosols.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Greg King
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Address
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Airway Physiology and Imaging Group
Level 4, Woolcock Institute of Medical Research
431 Glebe Point Rd
Glebe NSW 2037
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Country
62970
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Australia
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Phone
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+61 2 9114 0413
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Fax
62970
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Email
62970
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[email protected]
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Contact person for public queries
Name
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Greg King
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Address
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Airway Physiology and Imaging Group
Level 4, Woolcock Institute of Medical Research
431 Glebe Point Rd
Glebe NSW 2037
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Country
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Australia
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Phone
62971
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+61 2 9114 0413
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Fax
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+61 2 9114 0011
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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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Greg King
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Address
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Airway Physiology and Imaging Group
Level 4, Woolcock Institute of Medical Research
431 Glebe Point Rd
Glebe NSW 2037
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Country
62972
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Australia
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Phone
62972
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+61 2 9114 0413
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Fax
62972
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+61 2 9114 0011
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Email
62972
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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.
Download to PDF