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Determinants Of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY)

18. juli 2014 oppdatert av: Professor Francine Ducharme, St. Justine's Hospital
The aim of the prospective cohort study is to: (1) document the magnitude of response to oral corticosteroids administered to children presenting to the emergency department with moderate or severe asthma and (2) quantify clinically available potential determinants of the response to corticosteroids, such as age, gender, triggers of the index exacerbation, environmental tobacco smoke (ETS), gene polymorphisms, and their interactions.

Studieoversikt

Status

Fullført

Forhold

Detaljert beskrivelse

The objective of the large multicentre cohort study is to quantify the response to oral corticosteroids in children aged 1 to 17 years presenting to the ED with a moderate or severe asthma exacerbation.

The main outcome is hospital admission within 72 hours of the oral corticosteroid administration.

Secondary outcomes include the change in Pediatric Respiratory Assessment Measure (PRAM), length of active treatment and other markers of response to therapy in the ED as well as markers of recovery over the next 10 days.

Studietype

Observasjonsmessig

Registrering (Faktiske)

1011

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Canada
      • Quebec, Canada, G1V 4G2
        • Centre Hospitaliser de l'Université Laval
    • Ontario
      • London, Ontario, Canada, N6A 2V5
        • Children's Hospital of London Health Sciences Centre
      • Ottawa, Ontario, Canada, K1H 8L1
        • Children's Hospital of Eastern Ontario
    • Quebec
      • Montreal, Quebec, Canada, H3T1C5
        • CHU Sainte-Justine (CHUSJ)
      • Montreal, Quebec, Canada, H3H 1P3
        • Montreal Children's Hospital (MCH)

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

1 år til 17 år (Barn)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Sannsynlighetsprøve

Studiepopulasjon

Children aged 1 to 17 years with moderate to severe asthma with Pediatric Respiratory Assessment Measure (PRAM) ≥4.

Beskrivelse

Inclusion Criteria:

  • Subject will be eligible if he/she:

    1. is aged 1 to 17 years,
    2. has not received any oral, IM or IV corticosteroid within the last 5 days?
    3. Presents to the hospital emergency department with an acute episode of cough, wheezing and/or dyspnea?

    4. Has asthma as defined as one or more of the following 6 criteria:

      (i) prior diagnosis of asthma made by a physician; OR (ii) prior documented episode of acute cough, wheezing and/or dyspnea with significant response to inhaled β2-agonists or to oral corticosteroids; OR (iii) in a child aged <2 years, 3 or more episodes of cough, wheezing and/or dyspnea, including the index visit; OR (iv) previous lung function tests showing significant reversibility post-bronchodilation (≥12% FEV1 or ≥25% Rrs at 4 to 8 Hz); OR (v) a positive provocation test (PC20 ≤8 mg/mL or Provocation Dose (to increase Rrs by 50% or more (PD50) ≤8 mg/mL), OR (vi) the current episode diagnosed or suspected of asthma by the emergency physician?

    5. have moderate or severe airway obstruction, defined as a Paediatric Respiratory Asthma Measure (PRAM) score >3 at baseline,

Exclusion Criteria:

  • Patient will be excluded if :

    1. he/she has another chronic respiratory condition (such as bronchopulmonary dysplasia or cystic fibrosis);
    2. there is a reasonable suspicion of bronchiolitis or foreign body aspiration;
    3. he/she has a prior history of hypersensitivity to salbutamol, ipratropium bromide or oral prednisone/prednisolone;
    4. he/she has a relative or absolute contraindication to receiving oral corticosteroids such as recent exposure to varicella or live vaccine in past 14 days,
    5. there is confirmed or suspected pregnancy.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
Oral corticosteroids (OCS)

All patients receive:

  1. Prednisone or Prednisolone at 1 mg/kg (in 1 site) or 2 mg/kg (in all other sites) (max. 50 mg); if vomiting prednisone/prednisolone: they receive dexamethasone (0.3 mg/kg, max. 10 mg)
  2. 2 to 3 doses of salbutamol within the first hour of therapy according to severity Those with severe exacerbations receive 3 treatments with salbutamol and ipratropium bromide within the initial hour of therapy.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Hospital admission
Tidsramme: 72 hours after oral corticosteroids administration
Hospital admission or Length of active treatment for 8 or more hours after the oral corticosteroid administration or ED return visit associated with hospital admission within 72 hours after the oral corticosteroid administration or ED return visit associated within 72 hours with length of active treatment for 8 or more hours after the oral corticosteroid administration
72 hours after oral corticosteroids administration

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Length of active treatment in hospital
Tidsramme: 8 hours after oral corticosteroid administration
8 hours after oral corticosteroid administration
Meeting the severity criteria for admission
Tidsramme: Within 4 hours of oral corticosteroid administration
Proportion of children with a PRAM score ≥4 within 4 hours of oral corticosteroid administration
Within 4 hours of oral corticosteroid administration
PRAM profile in the ED
Tidsramme: Within 4 hours of oral corticosteroid administration
Area under the curve of the PRAM measured hourly for the time of oral corticosteroid (OCS) until 4 hours after OCS
Within 4 hours of oral corticosteroid administration
Time to meeting discharge criteria
Tidsramme: Within 8 hours of oral corticosteroid administration
Time until PRAM score ≤ 3
Within 8 hours of oral corticosteroid administration
Change in respiratory resistance
Tidsramme: Within 4 hours of oral corticosteroid administration
Change in respiratory resistance between baseline and disposition will be documented on the MasterScreen Impulse Oscillometry (Cardinal Health Canada, Montreal, Canada) using previously described standardized techniques in cooperative children aged ≥3 years. (measured in a subset of individuals)
Within 4 hours of oral corticosteroid administration
Unscheduled visits for asthma
Tidsramme: Within 7 days of the index ED exacerbation
unscheduled visits for asthma as reported by parents and confirmed by medical charts.
Within 7 days of the index ED exacerbation
Symptom score
Tidsramme: Within 7 days of the index ED exacerbation
Area under the curve of symptoms measured daily on the validated Asthma flare-up diary for children
Within 7 days of the index ED exacerbation
Duration of asthma symptoms
Tidsramme: Within 7 days of the index ED exacerbation
Duration of symptoms measured daily on the validated Asthma flare-up diary for children
Within 7 days of the index ED exacerbation
Cumulative reliever use
Tidsramme: Within 7 days of the index ED exacerbation
Cumulative number of puffs of reliever medication as recorded daily on the Asthma flare-up diary for children
Within 7 days of the index ED exacerbation
Duration of use of rescue ß2-agonists
Tidsramme: Within 7 days of the index ED exacerbation
Duration of use of rescue ß2-agonists as recorded on the Asthma flare-up diary for children
Within 7 days of the index ED exacerbation

Andre resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Adverse events
Tidsramme: Within 7 days of the index ED exacerbation
Number of children with vomiting, serious Infection, psychosis, and mood disturbances
Within 7 days of the index ED exacerbation
Serious Adverse Health Events
Tidsramme: Within 7 days of the index ED exacerbation
Number of children with adverse events requiring hospitalization, prolonged hospitalization, life threatening, other medically important events or associated with significant disability or incapacity
Within 7 days of the index ED exacerbation

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

St. Justine's Hospital

Samarbeidspartnere

Canadian Institutes of Health Research (CIHR)

Etterforskere

  • Hovedetterforsker: Francine M Ducharme, MD., M.Sc., CHU Sainte Justine, University of Montreal

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. januar 2011

Primær fullføring (Faktiske)

1. januar 2014

Studiet fullført (Faktiske)

1. januar 2014

Datoer for studieregistrering

Først innsendt

11. desember 2013

Først innsendt som oppfylte QC-kriteriene

11. desember 2013

Først lagt ut (Anslag)

17. desember 2013

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

22. juli 2014

Siste oppdatering sendt inn som oppfylte QC-kriteriene

18. juli 2014

Sist bekreftet

1. juli 2014

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • CHUSJ

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