Low Exhaled NO and ICS in Suspected Asthma (LowNO)

May 12, 2016 updated by: University of Nottingham

Does a Low Exhaled Nitric Oxide Level Exclude a Clinical Benefit From Inhaled Corticosteroids in Suspected Asthma: A Randomised, Placebo Controlled Trial

The purpose of this study is to determine whether a low exhaled nitric oxide reading (<27ppb) is a good predictor of a negative response to inhaled steroid treatment for patients with symptoms suggestive of asthma.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

At the first visit, which will take place at either at the GP surgery or the Nottingham Respiratory Research Unit (NRRU) informed written consent for the study will be obtained. The patients will then have an exhaled NO measurement, spirometry, venepuncture (for Full Blood Count and research blood - if consent obtained) taken and complete an Asthma Control Questionnaire (ACQ), Medical Research Council dyspnoea scale (MRC) and Leicester Cough Questionnaire (LCQ). All procedures will be carried out by the NRRU research nurse.

The investigators may use the NRRU existing database of research volunteers to recruit as necessary and also the respiratory clinics held at the NUH. If patients from clinics are recruited they will be initially approached by their usual care doctor and an information sheet will be sent / given to them accordingly.

If all the inclusion criteria are met and none of the exclusion criteria, the patients will be randomised to receive either a placebo inhaler, to be taken one puff twice daily, or a low dose inhaled steroid treatment, Budesonide 200mcgs via Turbuhaler one puff twice daily, for 3 months. Dr Tim Harrison will be prescribing the inhalers and they will be dispensed from the Nottingham City Hospital Clinical Trials Pharmacy and delivered/given to the patient by the research nurses.

Participants will be asked to return for follow up visits at 4 weeks, 8 weeks and 12 weeks following randomisation. At these follow up visits, exhaled NO, spirometry and the 3 questionnaires will be repeated.

Study Type

Interventional

Enrollment (Anticipated)

165

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Aged 18 years or over.
  2. Asthma suspected by GP/Practice Nurse
  3. Must be able to give informed consent
  4. Exhaled Nitric Oxide reading <27ppb
  5. FEV1 >70% predicted

Exclusion Criteria:

  1. Patients requiring oral steroid treatment on visit to GP/Practice nurse
  2. Use of oral prednisolone or antibiotics within last 4 weeks
  3. Already using an inhaled corticosteroid
  4. Any other clinically significant co-morbidity.
  5. Expectant or breast feeding mothers.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Budesonide (Pulmicort)
Low dose inhaled corticosteroid.
Drug: Budesonide (Pulmicort)
Budesonide (Pulmicort) - inhaled low dose inhaled steroid - I puff to be taken twice daily
Placebo Comparator: Placebo - dummy inhaler
Drug: Placebo - dummy inhaler
Placebo - dummy inhaler to be taken 1 puff twice daily.
Other Names:
  • Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Difference in Asthma Control Questionnaire (ACQ-7) between the inhaled steroid and placebo group adjusted for differences in baseline. The ACQ will measure the level of asthma control in the ICS and placebo group.
Time Frame: overall 12 weeks
Data will be collect via questionnaire at each visit. A change in ACQ-7 of 0.5 is considered clinically important.
overall 12 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Difference in FEV1 between inhaled steroid and placebo groups adjusted for differences in baseline.
Time Frame: overall 12 weeks
FEV1 will be measured in Litres.
overall 12 weeks
Measure cough symptoms with the LCQ between ics and placebo group adjusted for differences in baseline.
Time Frame: overall 12 weeks
A minimal important difference in LCQ is 1.3. This will be assessed using this validated, self-reported measure of quality of life for cough.
overall 12 weeks
Difference in a subjective measurement of MRC dyspnoea scale.
Time Frame: overall 12 weeks
This is a subjective scale of breathlessness graded 1-5 (5 being most breathless). This will be assessed from baseline measurements.
overall 12 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
The incidence of asthma exacerbations will be recorded for each group and compared.
Time Frame: 12 weeks
The number of asthma exacerbations will be captured from verbal feedback from specific patient questioning at study visits.
12 weeks
The deterioration in asthma control as measured by ACQ-7 and compared between groups.
Time Frame: 12 weeks
deterioration in asthma control will be captured from the ACQ- 7
12 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Nottingham

Investigators

  • Principal Investigator: Tim Dr Harrison, MD, University of Nottingham

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2016

Primary Completion (Anticipated)

July 1, 2017

Study Completion (Anticipated)

July 1, 2018

Study Registration Dates

First Submitted

April 28, 2016

First Submitted That Met QC Criteria

May 12, 2016

First Posted (Estimate)

May 13, 2016

Study Record Updates

Last Update Posted (Estimate)

May 13, 2016

Last Update Submitted That Met QC Criteria

May 12, 2016

Last Verified

May 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 16013

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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