Usefulness of Oscillometry in Assessing the Effectiveness of Inhaled Corticosteroides in Patients With COPD Exacerbator Phenotype
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 63
- 试验地点
- 1
- 主要终点
- Oscillometric results
研究概览
简要总结
The objective of this observational study is to determine the effectiveness of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) and frequent worsening of their respiratory symptoms by using a device called an oscillometer. This instrument is capable of measuring bronchial obstruction and air trapping in the lungs through vibrations during normal breathing. The main question it seeks to answer is:
Could oscillometry be useful in assessing the effectiveness of inhaled corticosteroids in patients with COPD exacerbations, in terms of bronchial obstruction and air trapping in the lungs? Patients who choose to participate will undergo oscillometry testing and complete standard COPD questionnaires during three follow-up visits spread over three months.
详细描述
Chronic obstructive pulmonary disease (COPD) is the most prevalent chronic respiratory disease worldwide, estimated at around 12% in Spain and 17.3% in Catalonia, despite significant underdiagnosis of up to approximately 74%. It is associated with high morbidity and mortality, being considered the third leading cause of death worldwide in 2021. Currently, spirometry represents the most standardized and well-known instrument for the diagnosis, control, and monitoring of COPD. However, the implementation of new tools is necessary to better define the characteristics of the disease and optimize its treatment. Furthermore, oscillometry is considered a quick and easy respiratory function test that allows the assessment of bronchial obstruction and emphysema by measuring pulmonary resistance and reactance, even in patients with normal spirometry. Its use in patients with asthma has allowed for comparisons of changes in airway obstruction with different inhaled corticosteroid (ICS) particles, with the aim of optimizing treatment choice. Therefore, its implementation in the study of patients diagnosed with COPD could also be very useful in this regard.
Main objective: To evaluate, using oscillometry, the therapeutic effectiveness of inhaled corticosteroids within triple closed therapy (LABA/LAMA/ICS) in a single device, compared to dual bronchodilation (LABA/LAMA), as maintenance treatment in patients with COPD exacerbators.
Methodology: This is an observational, prospective, multicenter study to be conducted in six hospitals in Catalonia, Spain. The goal is to include 63 patients diagnosed with COPD exacerbators, receiving dual bronchodilation treatment and meeting the endpoints for initiation of triple inhaled therapy, according to clinical practice guidelines (GesEPOC 2021, GOLD 2023). The device will be selected based on medical criteria, using the various closed-loop triple therapy inhalers currently available on the market. An initial oscillometry test will be performed to classify patients according to the predominant pattern: central obstruction, peripheral obstruction, and/or pulmonary hyperinflation. This initial measurement will be taken prior to changing treatment and immediately after the first dose of the new triple therapy inhaler. Subsequently, during patient follow-up, oscillometry will be repeated at 2, 4, and 12 weeks. The quality of life questionnaire (QLQ) and the inhaler adherence test will be self-administered at each visit. Data will be collected from the patients' electronic medical records and from laboratory tests performed during the previous year.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age over 18 years.
- •Diagnosis of COPD.
- •Severe-moderate COPD measured by FEV1 and stable.
- •Patient receiving dual bronchodilation therapy (LABA/LAMA) for at least the last 4 months prior to study inclusion and meeting clinical criteria to begin triple inhaled therapy.
- •COPD exacerbations (COPD exacerbations).
- •Blood eosinophils >100 cells/mL in prior laboratory tests.
- •Patient agrees to participate in the study and signs the informed consent form.
排除标准
- •COPD in the last 4 weeks, with use of antibiotics or systemic corticosteroids.
- •Chronic lung disease other than COPD.
- •Severe heart failure, with frequent decompensation (in cases of mild decompensation or onset without severe heart disease, do not include the patient within 3 months of decompensation).
- •Active neoplastic processes.
- •Severe renal failure.
- •ALT greater than 2.5 times the upper limit of normal.
- •Poorly controlled insulin-dependent diabetes or involvement of 1 or more organs.
- •Positive COVID-19 test (do not include until 3 months after diagnosis by ART or COVID-19 PCR).
- •Previous treatment with ICS in the last 4 months.
结局指标
主要结局
Oscillometric results
时间窗: on each of the 3 visits (baseline, week 4, week 12)
R19, R5, R5-19, X19, X5, ∆Xrs (cmH2O/(L/s)
次要结局
- Spirometric results(initial and at visit 3 (baseline and week 12))
- COPD Assessment Test (CAT)(on each of the 3 visits (baseline, week 4, week 12))
- Test of Adherence of Inhalers (TAI)(on each of the 3 visits (baseline, week 4, week 12))
- Spirometric results (forced expiratory volume in 1 second to forced vital capacity ratio)(initial and at visit 3 (baseline and week 12))
研究者
Yuliana Pascual González
Pneumologist
Hospital Universitari de Bellvitge