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Trial registered on ANZCTR
Registration number
ACTRN12612000015842
Ethics application status
Not yet submitted
Date submitted
21/12/2011
Date registered
4/01/2012
Date last updated
4/01/2012
Type of registration
Prospectively registered
Titles & IDs
Public title
A randomised, cross-over trial of upright sitting with or without positive expiratory pressure during nebulised delivery of medication to improve the pattern of aerosol deposition in healthy participants
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Scientific title
Randomised trial of positive expiratory pressure (PEP) to improve deposition in healthy participants
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Secondary ID [1]
279641
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Nil
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Universal Trial Number (UTN)
U1111-1126-6036
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Healthy participants (to be compared to participants with cystic fibrosis of a similar age)
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Condition category
Condition code
Respiratory
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0
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Normal development and function of the respiratory system
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Human Genetics and Inherited Disorders
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0
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Cystic fibrosis
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants will inhale 4mL technetium-99m DTPA radioaerosol in random order throughout the nebulisation period of 20 minutes for each of the regimens on two separte days: 1. Standard nebulisation period of 20 minutes, or
2. Nebulisation period of 20 minutes with the addition of a positive expiratory pressure device.
The two study days will have a minimum of 48 hours washout between them and not greater than 7 days (to ensure clinical stability).
After each nebulisation a gamma camera will perform a 20 minute deposition scan incorporating a transmission scan to outline the three-dimensional margin of the lung fields. This data will be reconstructed to determine the distribution of the deposited radioaerosol in the lungs.
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Intervention code [1]
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Treatment: Other
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Intervention code [2]
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Treatment: Devices
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Comparator / control treatment
Nebulisation period of 20 minutes with the addition of a positive expiratory pressure device is the comparator treatment.
Standard nebulisation period of 20 minutes is the control condition.
A concurrent study (registered separately will include participants of similar age who will undertake the sme protocol and be a comparator group during analysis
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Control group
Active
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Outcomes
Primary outcome [1]
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The 3-dimensional map of the lung fields will be divided into unit volumes (voxels). The amount of radioactivity in each voxel will be calculated. The standard deviation of the radioactivity across all voxels within the margins of the lung fields will be used as an index of uniformity of the pattern of deposition for each participant.
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Assessment method [1]
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Timepoint [1]
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Immediately post 20 minutes of inhalation
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Secondary outcome [1]
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The ratio of central:peripheral deposition of radioactivity will be determined by the mean number of counts per voxel in the central lung field divided by the mean number of counts per voxel in peripheral the lung field.
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Assessment method [1]
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Timepoint [1]
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Immediately post 20 minutes of inhalation
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Secondary outcome [2]
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The ratio of apical:non-apical deposition of radioactivity will be determined by the mean number of counts per voxel in the apical one third of the lung field divided by the mean number of counts per voxel in the basal two thirds of the lung field.
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Assessment method [2]
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Timepoint [2]
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Immediately post 20 minutes of inhalation
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Secondary outcome [3]
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The deposition fraction will be calculated as the amount of radioactivity in the lung fields divided by the amount of radioactivity in the nebuliser before inhalation, with correction for decay.
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Assessment method [3]
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Timepoint [3]
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Immediately post 20 minutes of inhalation
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Eligibility
Key inclusion criteria
Inclusion Criteria: To participate in this study, a person must:
1 be 18 years of age or older
2 be able to read, write and comprehend English
3 have normal lung function, with greater than or equal to 80% predicted FEV1
4 be willing to inhale a 4mL radioaerosol and undergo a 20-minute gamma scan, on two occasions.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Exclusion Criteria: A person will be ineligible to participate in this study if s/he:
1 has any respiratory condition
2 has significant malignant, neurological or musculoskeletal conditions
3 is unable to perform spirometry reproducibly
4 is pregnant, or is sexually active and unwilling to use contraception during the study
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Potential participants will be invited to read an Information for Participants document, and sign a consent form to participate in the study. Eligibility will then be confirmed with reference to the willing participant’s spirometry in standing according to the most recent American Thoracic Society criteria Participants will then be randomised via a coin toss by a blinded investigator to regimen "1. or 2." for their first study day (but will be unaware of the accociated regimen). 1. Standard nebulisation period of 20 minutes, or
2. Nebulisation period of 20 minutes with the addition of a positive expiratory pressure device.
Participants will be requested to adopt this strategy and maintain a normal tidal breathing pattern during the subsequent standard study inhalation. When participants return for their second study day, they will adopt the other inhalation regimen.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Coin toss for the first inhalation strategy performed by a blinded investigator.
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
Nil
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/03/2012
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
15
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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Physiotherapy Research Foundation
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Address [1]
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Level 1, 1175 Toorak Road, Camberwell VIC 3124
Postal Address: PO Box 437, Hawthorn BC VIC 3122
Phone: (03) 9092 0837 Fax: (03) 9092 0899
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Royal Prince Alfred Hospital
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Address
Missenden Road
Camperdown NSW 2050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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None
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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SLHD (RPA Zone)
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Ethics committee address [1]
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Missenden Road Camperdown NSW 2050
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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14/12/2011
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Approval date [1]
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Ethics approval number [1]
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HREC/11/RPAH/646
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Summary
Brief summary
Research question: To determine whether the addition of positive expiratory pressure (PEP) improves uniformity of deposition of an inhaled aerosol in upright sitting in healthy participants. Methods: Inclusion criteria: greater than or equal to18 years of age, normal lung function. Participants will inhale a 4mL radioaerosol in two stategies in random order throughout the nebulisation period of 20 minutes: 1. Standard nebulisation period of 20 minutes, or 2. Nebulisation period of 20 minutes with the addition of a PEP device. After each nebulisation a gamma camera will perform a 20-minute deposition scan incorporating a transmission scan to outline the three-dimensional margin of the lung fields. This data will be reconstructed to determine the distribution of the deposited radioaerosol in the lungs. A 15% improvement in uniformity of deposition is the proposed minimum difference that would make further investigation of the PEP strategy worthwhile in patient populations. Significance of project: In many patient populations (eg, cystic fibrosis, HIV and bronchiectasis), the pattern of deposition of inhaled medication is poor and non-uniform. The ability to deliver a drug more uniformly to the lung using the addition of PEP may have a significant impact on treatment efficacy for people with lung disease. Data from healthy participants will aid interpretation of subsequent studies in patients.
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Trial website
Nil
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Trial related presentations / publications
Nil
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Ruth Dentice
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Address
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Department of Respiratory Medicine Level 11
Royal Prince Alfred Hospital
Missenden Road Camperdown NSW 2050
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Country
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Australia
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Phone
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61 2 95155234
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Fax
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61 2 95158196
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Email
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[email protected]
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Contact person for scientific queries
Name
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Ruth Dentice
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Address
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Department of Respiratory Medicine Level 11
Royal Prince Alfred Hospital
Missenden Road Camperdown NSW 2050
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Country
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Australia
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Phone
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61 2 95155234
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Fax
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61 2 95158196
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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