- ICH GCP
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- Essai clinique NCT04696965
Appropriate Inhaler Use of Tiotropium as add-on Therapy in Symptomatic Asthma
Appropriate Inhaler Use of Tiotropium as add-on Therapy to Inhaled Glucocorticoids (ICS) With Long-acting Beta-agonists (LABA) in Adult Patients With Symptomatic Asthma: The Impact of Checking and Correcting Inhaler Technique in Real World
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
- The clinical efficacy of tiotropium as add-on treatment to ICS with a LABA have been demonstrated in clinical trials in adult patients with symptomatic asthma.
- Certain patients of daily care, like patients with smoking asthma, late onset asthma or asthma with chronic airway obstruction are often excluded from clinical trials.
- Studies have shown the cognitive function of patients with COPD is impaired. When mixed types of inhaler devices are prescribed, the multiple steps of different devices may ensure complexity and confusion for patients, which may compromise the efficacy of add-on therapy. The inhaler error of add-on tiotropium treatment in real-world asthma treatment is unknown.
- The improvement of step errors after varieties of teaching intervention is around 30~50%. Strategy of recheck inhaler technique recommended by the treatment guideline may optimized inhaler use. (https://ginasthma.org/gina-reports/).
- Factors like responseness of short-acting bronchodilators and cholinergic tone have been reported as predictors of a positive clinical response of add-on tiotropium. However, more specific physiological or inflammatory factors. e.g. exhaled nitric oxide test (FeNo), and para symptomatic function and cardiac-pulmonary interaction have not been evaluated prospectively.
- This pragmatic, two-arm, randomized controlled trial study aim to survey the inhaler errors of add-on tiotropium therapy with ICS+LABA in real-world practice of asthma patients and the efficacy of recheck stratage of inhaler skills. Patient characteristics and inflammatory features will be evaluated prospectively for association of asthma control by add-on tiotropium.
Type d'étude
Inscription (Anticipé)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
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Taoyuan, Taïwan, 33305
- Recrutement
- Department of Thoracic Medicine, Chang Gung Memorial Hospital
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Contact:
- Ting-Yu Lin, MD
- Numéro de téléphone: 8157 886-3-3281200
- E-mail: yuebaoyuebao@yahoo.com.tw
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Age 20 to 75 years old asthmatic patients under regular treatment
- Received medium to high dose ICS with LABA at least 3 months
- Persistent asthma related symptoms: asthma control questionnaire (ACQ-7>1.5)
- Physicians in charged prescribed Tiotropium as add-on therapy according to clinical judgement.
Exclusion Criteria:
- Refuse to provide inform consent
- Pregnancy or breastfeeding women
- Patients with chronic obstructive pulmonary disease
- Using other Long-acting Muscarinic Antagonists e.g. Sebree, Ultibro, Anoro and Spiolto
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Correct/recheck strategy
Patients of study arm will be asked to show how they use their two inhalers and identify errors using a device-specific checklist by research assistant.
Research assistant then show the patient how to use these devices correctly and give the checklist including the steps patients did wrong.
After teaching by the research assistant, patients were asked to demonstrate the correct way of wrong step(s) they made at beginning.
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One month after recruitment and every 3 months.
1. Check the inhaler step errors of patients by research assistant; 2.Demonstrate the right way by research assistant; 3. give the inhaler check list with marks of the wrong step(s) patients made to patients and 4. confirm the patients do the right way of the previous wrong step(s).
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Comparateur actif: Usual verbal instruction
Patients of control arm will be asked to show how thy use their two inhalers and identify errors using specific check list by research assistant.
The educational nurse will give verbal instruction.
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One month after recruitment and every 3 months.1.
Check the inhaler step errors of patients by research assistant; 2. Verbal instruction with a physical demonstration will be given by educational nurse in usual care.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
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Errors rate of Inhaler steps
Délai: 3 months
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The improvement of inhaler steps errors after recheck stratage after 3 month of add-on tiotropium and ICS+LABA
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3 months
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
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Contrôle de l'asthme
Délai: 3 mois
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L'amélioration du contrôle de l'asthme évaluée par Asthma Control Test (ACT).
Les scores vont de 5 (mauvais contrôle de l'asthme) à 25 (contrôle complet de l'asthme), les scores les plus élevés reflétant un meilleur contrôle de l'asthme.
Un score ACT > 19 indique un asthme bien contrôlé.
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3 mois
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Asthma control
Délai: 3 months
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The improvement of asthma control evaluated by Asthma Control Questionnaire-7 (ACQ-7). ACQ-7 is 7-point scale (0=no impairment, 6= maximum impairment for symptoms and rescue use; and 7 categories for FEV1%) |
3 months
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Forced expiratory volume in one second (FEV1) before bronchodilation
Délai: 3 months
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The improvement of FEV1 before bronchodilation evaluated by spirometry after 3 month of add-on tiotropium and ICS+LABA
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3 months
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Acute exacerbation
Délai: 3, 6,9 and 12 month
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The rate of acute exacerbation in one year
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3, 6,9 and 12 month
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Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
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Correlation of the errors rate of Inhaler steps and mini-cog score
Délai: 1 month
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The mini-cog score will be evaluated when patient recruitment. The mini-cog is score of five-points in total, a score of zero, one or two indicates a concern in cognitive functioning. The error of inhaler steps will be recorded one month after 3 month of add-on tiotropium and ICS+LABA. Correlation will be tested via Pearson's test or Sperman rank correlation test. |
1 month
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Correlation of the errors rate of Inhaler steps and poor asthma control
Délai: 3 month
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The error of inhaler steps will be recorded one month after add-on tiotropium therapy. Asthma control will be evaluated by Asthma Control Test (ACT) 3 months after 3 month of add-on tiotropium and ICS+LABA. Correlation will be tested via Pearson's test or Sperman rank correlation test. The distribution of errors rate of inhaler steps between patients with asthma well control (ACT>19) and patients with asthma poor control (ACT<=19) will be tested by Mann-Whitney test. |
3 month
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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Ting-Yu Lin, Chest department, Chang-Gung Memorial Hospital, Linkou branch
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Anticipé)
Achèvement primaire (Anticipé)
Achèvement de l'étude (Anticipé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 202002047B0
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Étudie un produit d'appareil réglementé par la FDA américaine
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Essais cliniques sur Correct/recheck strategy
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MED-EL Elektromedizinische Geräte GesmbHRecrutementPerte auditive neurosensorielle, bilatéraleFrance