- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03438019
Inspiratory Muscle Training in COPD
July 18, 2018 updated by: Michael Campos, Miami VA Healthcare System
Inspiratory Muscle Strength and Endurance Training in Veterans With COPD
This proposal aims at evaluating an inspiratory muscle training (IMT) method not previously tested in COPD called the Test of Incremental Respiratory Endurance (TIRE).
As a training method, TIRE promises to provide further benefits over standard IMT because it allows the user to adjust training loads as progress is made, adjusts the training based on day-to-day variations commonly noted in COPD, and provides a graphic representation of the inspiratory effort throughout all inspiration with real-time biofeedback in order to "coach" the user in performing the exercises.
The TIRE device can also be used as an assessment tool, not only to measure the commonly used measure of inspiratory muscle strength Maximal Inspiratory Pressure (MIP), but also measuring the MIP variation generated throughout a maximal sustained inspiration.
In this way, TIRE integrates MIP over the inspiratory duration (ID), providing a novel derivative measure called the sustained maximal inspiratory pressure or SMIP, that is likely a better surrogate of inspiratory muscle performance in COPD based upon preliminary data.
The main goal of this trial is to fully evaluate the utility of TIRE as an IMT method in veterans with COPD.
The investigators hypothesize that as a stand-alone therapy, TIRE training is superior to standard IMT in improving inspiratory muscle strength and endurance and in improving COPD-related clinical outcomes.
Study Overview
Status
Unknown
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
36
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Florida
-
Miami, Florida, United States, 33125
- Recruiting
- Bruce W Carter VAMC
-
Contact:
- Magno F. Formiga, PT
- Phone Number: 4064 305-575-7000
- Email: magno@miami.edu
-
-
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
38 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Male or female aged > 40 years with a confirmed diagnosis of COPD by a pulmonologist (presence of risk factors and airflow obstruction) and evidence of inspiratory muscle weakness as defined by the latest American Thoracic Society / European Respiratory Society statement on respiratory muscle training.
Exclusion Criteria:
- Refusal to participate in the study, subjects actively undergoing pulmonary rehabilitation, inability to perform the required maneuvers (i.e. patients with cerebrovascular accident or tracheostomy), subjects not in their stable state (i.e. having an acute exacerbation or within 4 weeks of having one) or presence of important comorbidities that may confound the interpretation of TIRE measures (i.e. decompensated heart failure, diaphragmatic paralysis, prior lung surgery, active cancer treatment, etc.). There will be no involvement of vulnerable populations.
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: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: TIRE IMT
The TIRE IMT group will receive a tablet with the TIRE software installed and a PrO2® device through which they will train.
Training consists of six levels (A-F) with six inspirations at each level for a total of 36 breaths.
Recovery times between breaths range from 40 to 5 seconds as the subject advances each level.
TIRE data will be stored in the tablet for subsequent interrogation and data retrieval.
|
The PrO2 device is linked to a tablet via Bluetooth and provides the user with a graphic representation of their inspiratory effort throughout all of inspiration and real-time biofeedback.
This device incorporates a standard 2mm leak to avoid glottal closure during maximal inspiration.
The PrO2 provides measures of MIP (cmH2O), SMIP (PTU) and ID (seconds).
Other Names:
|
Experimental: Standard IMT group
The Standard IMT group will receive a Threshold® Inspiratory Muscle Trainer.
This device incorporates a flow-independent one-way valve to ensure consistent resistance and features an adjustable specific pressure setting to be set based on MIP values of each subject.
Subjects will be instructed to perform up to 36 breaths daily.
To compare with TIRE training, we will ask participants to perform this within a 30-minute session.
|
The Threshold incorporates a flow-independent one-way valve to ensure consistent resistance and features an adjustable specific pressure setting to be set based on MIP values of each subject.
|
Sham Comparator: Sham IMT group
The Sham IMT group will also receive a Threshold® device and undergo the exact protocol of group 2 but with minimal resistance applied (7 cm H2O, the lowest in the device).
|
The Threshold incorporates a flow-independent one-way valve to ensure consistent resistance and features an adjustable specific pressure setting to be set based on MIP values of each subject.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sustained Maximal Inspiratory Pressure (SMIP)
Time Frame: Change from baseline to 8 weeks.
|
SMIP is obtained from a maximal sustained inspiratory effort performed through the TIRE method using the PrO2 device.
SMIP is documented in pressure time units (PTU) and represents the area under the curve generated from the start to the end of inspiration, from residual volume to total lung capacity.
|
Change from baseline to 8 weeks.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Maximal Inspiratory Pressure (MIP)
Time Frame: Change from baseline to 8 weeks.
|
MIP is obtained from a maximal inspiratory effort from residual volume using the TIRE software and recorded in centimeters of water.
|
Change from baseline to 8 weeks.
|
Inspiratory Duration (ID)
Time Frame: Change from baseline to 8 weeks.
|
ID is obtained from a maximal and sustained inspiratory effort using the TIRE software and recorded in seconds.
|
Change from baseline to 8 weeks.
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Six-minute Walk Test (6MWT)
Time Frame: Change from baseline to 8 weeks.
|
Sub-maximal exercise test used to assess aerobic capacity and endurance.
The best distance covered over a time of 6 minutes is recorded in metres.
|
Change from baseline to 8 weeks.
|
St.George's Respiratory Questionnaire (SGRQ)
Time Frame: Change from baseline to 8 weeks.
|
The SGRQ is a 50-item questionnaire developed to measure health status (quality of life) in patients with diseases of airways obstruction.
Scores range from 0 to 100, with higher scores indicating more limitations.
|
Change from baseline to 8 weeks.
|
Modified Medical Research Council (mMRC) Dyspnea Scale
Time Frame: Change from baseline to 8 weeks.
|
This scale ranges from zero to four, with higher scores indicating a greater degree of breathlessness.
|
Change from baseline to 8 weeks.
|
COPD Assessment Test (CAT)
Time Frame: Change from baseline to 8 weeks.
|
This instrument that can quantify the impact of COPD on the patient's health.
The CAT has a scoring range of 0-40.
Higher scores denote a more severe impact of COPD.
|
Change from baseline to 8 weeks.
|
Fat Free Mass Index (FFMI)
Time Frame: Change from baseline to 8 weeks.
|
FFMI is calculated using the following formula: FFMI = (Lean Mass / 2.2) / ((Height in feet * 12.0) * 0.0254) squared.
A person is said to be in the Average Norms of Muscle Mass Interpretation when his FFMI in pounds is between 18 and 19.
|
Change from baseline to 8 weeks.
|
Short Performance Physical Battery (SPPB)
Time Frame: Change from baseline to 8 weeks.
|
The SPPB is a group of measures that combines the results of the gait speed, chair stand and balance tests.
The scores range from 0 (worst performance) to 12 (best performance).
|
Change from baseline to 8 weeks.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
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 (Actual)
June 18, 2018
Primary Completion (Anticipated)
July 1, 2019
Study Completion (Anticipated)
July 31, 2019
Study Registration Dates
First Submitted
February 8, 2018
First Submitted That Met QC Criteria
February 15, 2018
First Posted (Actual)
February 19, 2018
Study Record Updates
Last Update Posted (Actual)
July 20, 2018
Last Update Submitted That Met QC Criteria
July 18, 2018
Last Verified
July 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1160788-1
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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