Effectiveness of the Aeroneb in Acute Severe Asthma

Not Applicable

Completed

Conditions: Asthma Exacerbation

Interventions: Device: Aeroneb nebulizer
Device: Small volume jet nebulizer

Registration Number: NCT03029156

Lead Sponsor: Tufts Medical Center

Brief Summary: Background: The bronchodilator therapy is an essential component of the management of asthma exacerbation. The delivery of bronchodilators to the lungs in asthma exacerbations is usually achieved through nebulization (creating small particles to be inhaled). The commonly used nebulizer device is a small volume jet nebulizer which has not been consistently reliable in delivering bronchodilator therapy. The Aeroneb nebulizer device is a FDA approved device which produces consistently respirable sized particles which could potentially result in better bronchodilator effect than the standard jet nebulizer.

Aim: To study whether the Aeroneb nebulizer is more effective than a small volume jet nebulizer in delivering bronchodilators during a severe asthma exacerbation.

Experimental design: Patients will be randomized (like a flip of a coin) to receive bronchodilator therapy as per the emergency room protocol either via small volume jet nebulizer or Aeroneb nebulizer.

Subjects: Adult patients between age of 18 and 55 years who present to the emergency room with severe asthma exacerbation with peak expiratory flow rate \<50% of predicted.

Study procedure: When enrolled in the study and after randomization, we will then collect data that is standard for the hospital like heart rate, blood pressure and breathing indices and also some non-routine things like some scoring scales for shortness of breath and serial measurements of peak expiratory flow rate. We anticipate that the Aeroneb device will be more effective in delivering bronchodilator medication and thus more effective in managing asthma exacerbations.

Detailed Description: * Patients presenting with acute severe asthma exacerbations to the emergency room will be screened by the PI, co-investigator or research coordinator to determine their eligibility based on the inclusion and exclusion criteria.

* Clinically indicated treatment must not be delayed for a research-related reason so patients will still be eligible for enrollment after receiving initial bronchodilator therapy as long as their PEFR remains \<50% of predicted and enrollment occurs within 90 minutes of the ER arrival time.

* The initial part of the consent process will cover the essential elements of the informed consent in a concise manner to ensure a timely process

* Eligible patients will be randomized using the concealed envelope method to either the intervention arm or the control arm. The randomization should take place within 90 minutes of ER arrival, however, every effort will be made to enroll the patient as soon as possible; patients will be enrolled as long as their PEFR is less than 50% of predicted regardless of the number of bronchodilator treatments they received prior to randomization.

* The assignment will be blinded to the recording investigator and the treating physician but not to the patient or the nurse or respiratory therapist who is administering the nebulization. In order to avoid any delay in administering the treatments, the sets of Aeroneb nebulizer and small volume jet nebulizer will be stored in identical boxes and will be readily available in the ER.

In order to blind the treating physician and the recording investigator, a sign "treatment in progress" will be displayed at the outdoor of the ER room when the patient is getting the bronchodilator treatment. The nebulizer devices will be placed in the box between the bronchodilator treatment sessions. The physician and the recording investigator will be asked if possible to see the patients only when the sign is taken off the outdoor.

* Once assigned, all the bronchodilator treatments in the ER will be administered using the nebulizer device assigned to that patient.

* The Peak flow and FEV1 will be measured using Spirometer (micro I). Both values will be obtained through the same exhalation maneuver.

* Patient will be treated and managed according to the asthma ER adult protocol or as directed by the ER physician who is in charge of patient's care

* After the study procedures have been performed and the subject is determined to be in stable condition and have the capacity to make medical decisions, the investigator will approach the subject again and review all the elements of the ICF again with the subject. The collected data will be used only if the subject signs both parts of the informed consent.

* Within two weeks of the subject participation, the research team will conduct a phone interview with the subject to obtain their feedback on the study procedures and mainly on the informed consent process. The phone interview questionnaire is included in the supplement

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 31

Inclusion Criteria

Acute asthma exacerbations presenting to the emergency room
Peak expiratory flow rate at presentation <40% of predicted
Enrolment within 90 minutes of the arrival to the ER
Age 18-55 years old

Exclusion Criteria

History of chronic obstructive pulmonary disease
Clinical evidence to suggest a non-asthmatic cause of bronchospasm as determined by the treating physician
Clinical evidence of acute coronary syndrome
Respiratory failure requiring mechanical ventilation either invasive or non-invasive
Tachyarrhythmia other than sinus
Agitated or uncooperative
Inability to provide informed consent

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Aeroneb nebulizer	Aeroneb nebulizer	Administration of bronchodilator via Aeroneb nebulizer. The nebulized solution contains ipratropium / albuterol.
Small volume jet nebulizer	Small volume jet nebulizer	Administration of bronchodilator through small volume jet nebulizer. The nebulized solution contains ipratropium / albuterol.

Primary Outcome Measures

Name	Time	Method
Percentage Change in Mean of Peak Expiratory Flow Rate (PEFR) Percentage of Predicted Baseline at 30 Minutes After the Initial Bronchodilator Treatment	30 minutes	Peak expiratory flow rate is the maximum flow rate generated during a forceful exhalation, starting from full inspiration.

Secondary Outcome Measures

Name	Time	Method
Percentage Change in the PEFR Percentage of Predicted Baseline to Disposition	Initial bronchodilator treatment to disposition, an average of 4 hours	Change in the PEFR percent predicted from the initial bronchodilator treatment in the Aeroneb group compared to the small volume jet nebulizer group.
Percentage Change in the Forced Expiratory Volume (FEV1) Percentage of Predicted Baseline to Disposition	initial bronchodilator treatment to disposition, an average of 4 hours	Forced expiratory volume refers to the volume of air that an individual can exhale during a forced breath in 1 second.
Change in Heart Rate Baseline to Disposition	The initial bronchodilator treatment to to disposition, an average of 4 hours	Change in the heart rate at baseline after the initial bronchodilator treatment in the Aeroneb group compared to the small volume jet nebulizer group.
Length of Stay in the ER	Length of stay in the ER - up to one day	Total length from admission to discharge.
Change in the Borg-Dyspnea Score From Baseline to Disposition	initial bronchodilator treatment to disposition, an average of 4 hours	The Borg-Dyspnea score measures an individual's effort, exertion, breathlessness and fatigue during physical work. This scale ranges from 6-20 with 6 representing no exertion at all and 20 representing maximal exertion.
Percentage of Patients Requiring Hospitalization	Length of stay in the ER - up to one day	Total amount of patients requiring hospitalization after ER admission.
The Total Dose of Albuterol Used in Each Group During ED Stay	Length of stay in the ER - up to one day	Albuterol is used to prevent and treat difficulty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases such as asthma and chronic obstructive pulmonary disease.