The Prevalence of Small Airways Dysfunction In COPD Patients and The Impact on COPD Control

Chronic obstructive pulmonary disease (COPD) is a worldwide prevalent disease. During recent years, increasing attention has been directed to the importance of the contribution of small airways in respiratory diseases. The small airways (usually defined as those with an internal diameter of <2 mm) are recognized as the major site of resistance to airflow in obstructive lung disease. Although small airway disease is known in chronic airway diseases, the importance of small airway dysfunction on disease control, exacerbations and quality of life, and the importance of taking place among treatable targets is not clear. Therefore, our aim in the study is to determine the frequency of small airway dysfunction in COPD. Our secondary aim is to evaluate the role of small airway dysfunction in disease severity, disease phenotypes, disease control, quality of life and its effect on predicting the risk of exacerbation and its role among treatable targets in chronic airway diseases.

Study Overview

• Status: Unknown
• Conditions: COPD; Small Airway Disease
• Intervention / Treatment: Diagnostic test: Impulse oscillometry; Diagnostic test: Spirometric pulmonary function test; Diagnostic test: Fractional exhaled nitric oxide (FENO) test; Diagnostic test: Thorax Computed Tomography; Diagnostic test: Blood eosinophil level; Other: CAT; Other: mMRC; Diagnostic test: Chest X Ray

Detailed Description

This is a prospective cross-sectional interventional design. 100 COPD patients who applied to Mersin University Faculty of Medicine Hospital Chest Diseases Clinic between 01.10.2019-01.04.2020 will be taken. 35 healthy participants with smoking history and 35 healthy participants without smoking history who were admitted to our clinic within the same date range will be taken as control group. Impulse oscillometric pulmonary function tests will be performed to all participants. Thorax computed tomography will be performed to evaluate small airway dysfunction. To evaluate the degree of disease inflammation and phenotype in COPD patients, nitric oxide measurements will be made in the breath air with fractional exhaled nitric oxide (FENO) device. The blood eosinophil level will be studied to determine the COPD phenotype. To assess symptom control in patients with COPD, mMRC(Modified Medical Research Council) dyspnea scale will be administered. The COPD assessment test (CAT) will be applied to measure the quality of life. All patients will be followed for 1 year to record the number of exacerbations requiring emergency and hospital admissions for COPD. The effect of small airway dysfunction on the disease severity and control degree, disease phenotypes and quality of life, and the effect on the risk of exacerbation will be analyzed.

• Study Type: Interventional
• Enrollment (Actual): 170
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Yenisehir
    • Mersin, Yenisehir, Turkey, 33070
      • Mersin University Faculty of Medicine, Department of Respiratory Diseases

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

COPD group

• Participants who applied to the chest diseases clinic of Mersin University Hospital, between October 1, 2019 and April 1, 2020
• Participants who were diagnosed COPD with spirometry test
• Reading and signing Informed Consent Form
• Participants must be older than 18 years

Healthy control group with a history of smoking

• To apply to the chest diseases clinic of Mersin University Hospital between October 1, 2019 and April 1, 2020
• Reading and signing informed consent form
• Participants must be older than 18 years
• Must have no lung disease
• Must have 10 packs / year or more than 10 packs / year smoking history

Healthy control group without smoking history

• To apply to the chest diseases clinic of Mersin University Hospital between October 1, 2019 and April 1, 2020
• Reading and signing informed consent form
• Participants must be older than 18 years
• Must have no lung disease
• Must have no smoking history

Exclusion Criteria:

• Participants who do not sign the Informed Consent Form
• Under the age of 18 years
• Pregnant women
• Participants who with a history of cancer in the past 5 years
• Participants who previously had lung surgery
• Participants who with Interstitial Lung Disease
• Participants who with respiratory muscle disease
• Participants who with active pulmonary tuberculosis
• Participants who can not perform respiratory function tests

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: COPD group; Impulse oscillometric pulmonary function tests and spirometric pulmonary function test will be performed.To evaluate the degree of disease inflammation and phenotype, nitric oxide measurements will be made in the breath air with fractional exhaled nitric oxide (FENO) device. Blood eosinophil values will be examined. Thorax computed tomography will be performed to evaluate small airway dysfunction. To assess symptom control in patients with COPD, a dyspnea scale of mMRC will be administered. The COPD assessment test (CAT) will be applied to measure the quality of life. All participants will be followed for 1 year to record the number of exacerbations requiring emergency and hospital admissions for COPD.	Diagnostic test: Impulse oscillometry; Impulse oscillometry is a pulmonary function test. During the test, the participant is told to breathe normally.; Diagnostic test: Spirometric pulmonary function test; In the spirometric pulmonary function test, the participant is asked to perform respiratory maneuvers such as breathing deeply.; Diagnostic test: Fractional exhaled nitric oxide (FENO) test; In the FENO test, the participant is asked to perform respiratory maneuvers such as breathing deeply.; Diagnostic test: Thorax Computed Tomography; Computed tomography is a radiological examination.; Diagnostic test: Blood eosinophil level; A tube of blood will be drawn from the participant.; Other: CAT; It consists of 8 questions.; Other: mMRC; It is the scale used to measure the severity of shortness of breath.
Other: Healthy control group with a history of smoking; Impulse oscillometric pulmonary function test, spirometric pulmonary function test and chest x ray will be performed.	Diagnostic test: Impulse oscillometry; Impulse oscillometry is a pulmonary function test. During the test, the participant is told to breathe normally.; Diagnostic test: Spirometric pulmonary function test; In the spirometric pulmonary function test, the participant is asked to perform respiratory maneuvers such as breathing deeply.; Diagnostic test: Chest X Ray; Chest X ray is a radiological examination.
Other: Healthy control group with no smoking history; Impulse oscillometric pulmonary function test, spirometric pulmonary function test and chest x ray will be performed.	Diagnostic test: Impulse oscillometry; Impulse oscillometry is a pulmonary function test. During the test, the participant is told to breathe normally.; Diagnostic test: Spirometric pulmonary function test; In the spirometric pulmonary function test, the participant is asked to perform respiratory maneuvers such as breathing deeply.; Diagnostic test: Chest X Ray; Chest X ray is a radiological examination.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Small airway dysfunction will be evaluated by performing impulse oscillometry test.	Respiratory resistance at 5 and 20 Hz (R5 and R20, respectively) will be used for the analyses. R5 and R20 are regarded as reflecting total and proximal airway resistance, respectively, and the fall in resistance from R5 to R20 (R5-R20) will used as a surrogate for the resistance of small airways.	through study completion, an average of 1 year
Small airway dysfunction will be evaluated by thorax computed tomography.	Indirect changes caused by the small airways on the lung parenchyma will be detected by computed tomography (CT).	through study completion, an average of 1 year
Small airway dysfunction will be evaluated by body plethysmography test.	Residual volume (RV) and total lung capacity (TLC) will be measured by body plethysmography test to determine small airway dysfunction.	through study completion, an average of 1 year
Symptoms will be evaluated by Modified Medical Research Council Dyspnea Scale (mMRC).	The mMRC (Modified Medical Research Council) scale is a self-rating tool to measure the degree of disability that breathlessness poses on day-to-day activities on a scale from 0 to 4: 0, no breathlessness except on strenuous exercise; 1, shortness of breath when hurrying on the level or walking up a slight hill; 2, walks slower than people of same age on the level because of breathlessness or has to stop to catch breath when walking at their own pace on the level; 3, stops for breath after walking ∼100 m or after few minutes on the level; and 4, too breathless to leave the house, or breathless when dressing or undressing.	through study completion, an average of 1 year
The number of moderate and severe exacerbations over a 1 year period will be recorded.	In the COPD group, each participant will be followed for 1 year in terms of recording exacerbations.	through study completion, an average of 1 year
Forced expiratory volume in 1 second (fev1) change will be evaluated by spirometric pulmonary function test.	Forced expiratory volume in 1 second (fev1) change over one year period will be evaluated with spirometric pulmonary function test during recruitment and 1st year of follow-up.	through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fractional Exhaled Nitric Oxide (FENO) test will be used as an indicator of inflammation.	FENO test is indirect measurements of inflammation, as used in clinical practice.	through study completion, an average of 1 year
Complete blood count ( CBC) test will be used as an indicator of inflammation.	Blood eosinophil levels will be recorded.	through study completion, an average of 1 year
Quality of life will be evaluated by COPD Assessment Test (CAT).	COPD Assessment Test (CAT) contains 8 questions. In each question, the minimum value is zero and the maximum value is five points. Higher score means worse outcome.	through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: Sibel Naycı
• Collaborators: Mersin University

Publications and helpful links

General Publications

• Crisafulli E, Pisi R, Aiello M, Vigna M, Tzani P, Torres A, Bertorelli G, Chetta A. Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease. Respiration. 2017;93(1):32-41. doi: 10.1159/000452479. Epub 2016 Nov 17.
• Bonini M, Usmani OS. The role of the small airways in the pathophysiology of asthma and chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2015 Dec;9(6):281-93. doi: 10.1177/1753465815588064. Epub 2015 Jun 2.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2019
• Primary Completion (Anticipated): September 1, 2020
• Study Completion (Anticipated): April 1, 2021

Study Registration Dates

• First Submitted: May 6, 2020
• First Submitted That Met QC Criteria: May 10, 2020
• First Posted (Actual): May 12, 2020

Study Record Updates

• Last Update Posted (Actual): May 12, 2020
• Last Update Submitted That Met QC Criteria: May 10, 2020
• Last Verified: May 1, 2020

More Information

Terms related to this study

• Keywords: COPD; Impulse oscillometry; Small Airway Dysfunction
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Vasodilator Agents; Autonomic Agents; Peripheral Nervous System Agents; Protective Agents; Bronchodilator Agents; Anti-Asthmatic Agents; Respiratory System Agents; Antioxidants; Free Radical Scavengers; Endothelium-Dependent Relaxing Factors; Gasotransmitters; Nitric Oxide
• Other Study ID Numbers: 2019-2-TP3-3539-2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No