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Amyotrophic Lateral SclerosisEarly Phase 1NCT02710110

Respiratory Strength Training in Persons With Amyotrophic Lateral Sclerosis (ALS)

A Early Phase 1 study testing PowerLung trainer, Micro Mouth Pressure Meter and Pulmonary Function Testing in people with Amyotrophic Lateral Sclerosis, run by University of Florida at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Dysphagia (swallow impairment), dystussia (cough impairment) and respiratory impairment are hallmark features of amyotrophic lateral sclerosis (ALS). These symptoms are the cause of fatal aspiration, malnutrition and respiratory insufficiency that together account for 91.4% of ALS mortality. Read more about this study

Who is it for?
Ages 21 to 85 years
Conditions the study is for
Amyotrophic Lateral Sclerosis
What is being tested?
PowerLung trainer, Micro Mouth Pressure Meter and Pulmonary Function Testing
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
50 participants
Where
1 siteUnited States
Study dates
Apr 2016to 7 Feb 2019
Phase
Early Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • diagnosis of probable or definite Amyotrophic Lateral Sclerosis (ALS),
  • Amyotrophic Lateral Sclerosis Rating Scale Revised score greater than 34,
  • forced vital capacity greater than 70%,
  • cognition within normal limits as determined by Montreal assessment of cognition score >25

Who cannot join

  • allergies to barium,
  • tracheotomy or mechanical ventilation,
  • diaphragmatic pacer,
  • concurrent respiratory disease (e.g. COPD),
  • pregnant at the time of the study due to radiation exposure

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UF Health Shands

    Gainesville, Florida, 32605

Other trials in United States

About this study

Official title: The Impact of Respiratory Strength Training in Individuals With Amyotrophic Lateral Sclerosis (ALS)

Dysphagia (swallow impairment), dystussia (cough impairment) and respiratory impairment are hallmark features of amyotrophic lateral sclerosis (ALS). These symptoms are the cause of fatal aspiration, malnutrition and respiratory insufficiency that together account for 91.4% of ALS mortality. Unfortunately, treatments to prolong and maintain these vital functions are currently lacking. Although the use of exercise in ALS is controversial, recent evidence suggests that mild to moderate intensity exercise applied early in the disease slows disease progression, improves motor function, preserves motor neuron number, reduces muscle hypoplasia, atrophy astrogliosis, and prolongs survival in animal models of ALS and human clinical trials.

This research study is designed to determine the impact of respiratory strength training on breathing, airway protection and swallowing in persons with Amyotrophic Lateral Sclerosis (ALS).

Read the detailed description

This research study will measure the maximum inspiratory and expiratory pressure with secondary measures of respiration, swallow, cough, quality of life and global disease progression following twelve-weeks of treatment compared to the sham group.

As a participant two evaluations at the University of Florida Swallowing Systems Core laboratory located at Shands Hospital, Gainesville will take place. Each will take approximately two-hours and these will be spaced exactly three-months apart. During each evaluation tests will be performed to look at breathing, swallowing, and ability to cough doing standard clinical exams. In addition, some surveys about eating, speaking and quality of life will be taken.

Breathing Exercises: a home research therapist will train the participants how to use the hand-held respiratory trainer. Training for both treatment groups will be very similar, except the PowerLung trainer device will have an additional spring load valve inside it that will place a force on the respiratory muscles during training. The other breathing trainer will not have this spring so that no resistance will be placed on the respiratory muscles during training and this will represent an aerobic respiratory treatment. The breathing exercises will be completed five days a week for a total of three months (a total of 60 therapy sessions). During each session, a total of three sets of ten repetitions of breathing exercises will be performed. Once a week the home research therapist will visit and guide participants through the breathing exercise.

Being tested
PowerLung trainer, Micro Mouth Pressure Meter, Pulmonary Function Testing, Videofluoroscopic swallowing study, Swallowing Quality of Life Questionnaire
Medical subject headings
Amyotrophic Lateral Sclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PowerLung trainerDevice

    PowerLung trainer will be utilized which has both an inspiratory and expiratory loading capacity for training. A single daily training session will consist of three sets of 10 repetitions for a total of 30 inspiratory repetitions and 30 expiratory repetitions (i.e. 60 repetitions) for 5 days a week, for 3 months.

  • Micro Mouth Pressure MeterDevice

    Also called digital manometer, Micro Medical device

    The participant will be seated with the nose occluded using a nose clip. After inhaling to total lung capacity, the participant will place his or her lips around the mouthpiece and blow out as forcefully as possible. A flange rubber mouthpiece will be used to overcome the inability of some individuals to create tight lip seal due to facial muscle weakness. Three trials will be performed and the patients highest Maximum Inspiratory Pressures (MIP) and Maximal Expiratory Pressure (MEP) used.

  • Pulmonary Function TestingProcedure or surgery

    Pulmonary Function testing will be performed using conventional methods and will include the following outcomes: forced vital capacity (FVC), sniff nasal inspiratory pressure (SNIP), peak expiratory flow (PEF), forced expiratory volume (FEV1) expressed as a percentage of predicted values.

  • Videofluoroscopic swallowing studyProcedure or surgery

    Also called VFSS, X-ray of swallowing

    Videofluoroscopic swallowing study will be performed to measure the oropharyngeal swallowing.

  • Swallowing Quality of Life QuestionnaireOther

    Also called SWAL-QOL

    Swallowing Quality of Life Questionnaire (SWAL-QOL) will be used for participant reporting of swallow-related quality of life.

  • Iowa Oral Pressure InstrumentDevice

    Also called IOPI

    The IOPI is a device that measures the peak pressure performance of lingual strength and endurance via the action of a bulb placed on the hard palate.

  • CapsaicinDrug

    Also called Hot pepper

    A capsaicin challenge with three randomized blocks of 0, 50, 100, 200, and 500 μM capsaicin. The capsaicin will be dissolved in a vehicle solution consisting of 80% physiological saline, and 20% ethanol. Participants will be given the instruction "cough if you need to" prior to capsaicin delivery.The solution will be administered automatically upon detection of an inspired breath and there will be a minimum of one minute between each trial. This is to test the reflexive cough testing for upper airway sensitivity and motor thresholds.

Study groups in NCT02710110
Study groupRoleWhat they receive
Active Respiratory TrainerExperimentalParticipants enrolled in this arm will be given the PowerLung trainer. The adjustable spring allows for discrete and calibrated changes to the valve, which in turn blocks air until sufficient inspiratory or expiratory pressure is applied by an individual. In addition, the Micro Mouth Pressure Meter, Pulmonary Function testing, videofluoroscopic swallowing study (VFSS), Swallowing Quality of Life Questionnaire (SWAL-QOL), Iowa Oral Pressure Instrument (IOPI), and capsaicin for use in the reflexive cough test.
Receives: Device: PowerLung trainer; Device: Micro Mouth Pressure Meter; Procedure: Pulmonary Function Testing; Procedure: Videofluoroscopic swallowing study; Other: Swallowing Quality of Life Questionnaire; Device: Iowa Oral Pressure Instrument; Drug: Capsaicin
Sham TrainerSham comparatorParticipants enrolled in this arm will be given the PowerLung trainer; however, the adjustable spring allows for discrete and calibrated changes to the valve and these will not have any resistance. In addition, the Micro Mouth Pressure Meter, Pulmonary Function testing, videofluoroscopic swallowing study (VFSS), Swallowing Quality of Life Questionnaire (SWAL-QOL), Iowa Oral Pressure Instrument (IOPI), and capsaicin for use in the reflexive cough test.
Receives: Device: PowerLung trainer; Device: Micro Mouth Pressure Meter; Procedure: Pulmonary Function Testing; Procedure: Videofluoroscopic swallowing study; Other: Swallowing Quality of Life Questionnaire; Device: Iowa Oral Pressure Instrument; Drug: Capsaicin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maximum Expiratory Pressure will be measured between the groups for a change from baseline to month 3

    Maximum expiratory pressure is a measure of force generating capabilities as assessed by having subjects quickly inhale then rapidly blow out air into a handheld manometer (Micro Mouth Pressure Meter). Three trails will be performed and the highest will be used.

    Measured: Changes from baseline to month 3

  2. Maximum Inspiratory Pressure will be measured between the groups for a change from baseline to month 3

    Maximum inspiratory pressure is a measure of force generating capabilities as assessed by having subjects quickly inhale then rapidly blow out air into a handheld manometer (Micro Mouth Pressure Meter). Three trails will be performed and the highest will be used.

    Measured: Changes from baseline to month 3

  3. Pulmonary function to measure the forced vital capacity (FVC) between the groups for a change from baseline to month 3

    Pulmonary Function testing will be performed using a micro pressure meter. The participant will perform a maximum inhalation and then slowly blow out air into the mouthpiece of the meter. The following measurement will be displayed on the meter after the exhalation is complete forced vital capacity (FVC) expressed as a percentage of predicted values.

    Measured: Changes from baseline to month 3

  4. Sniff Nasal Inspiratory Pressure will be measured between the groups for a change from baseline to month 3

    Measured: Changes from baseline to month 3

  5. Pulmonary function to measure the peak expiratory flow (PEF) will be measured between the groups for a change from baseline to month 3

    Pulmonary Function testing will be performed using a micro pressure meter. The participant will perform a maximum inhalation and then slowly blow out air into the mouthpiece of the meter. The following measurement will be displayed on the meter after the exhalation is complete peak expiratory flow (PEF) expressed as a percentage of predicted values.

    Measured: Changes from baseline to month 3

  6. Pulmonary function to measure the forced expiratory volume (FEV1) will be measured between the groups for a change from baseline to month 3

    Pulmonary Function testing will be performed using a micro pressure meter. The participant will perform a maximum inhalation and then slowly blow out air into the mouthpiece of the meter. The following measurement will be displayed on the meter after the exhalation is complete forced expiratory volume (FEV1) expressed as a percentage of predicted values.

    Measured: Changes from baseline to month 3

Secondary outcomes (5)
  1. The Penetration-aspiration scale will be used to measure swallowing function

    Videofluoroscopic swallowing study will be performed to measure the oropharyngeal swallowing.

    Measured: Changes from baseline to month 3

  2. Lingual strength will be measured between the groups for a change from baseline to month 3

    The Iowa Oral Pressure Instrument device will measure the peak performance of lingual strength a via the action of a bulb placed on the hard palate. To assess maximum anterior isometric pressure, the bulb will be placed on the roof of the mouth and the participant will raise his or her tongue to apply pressure to this bulb and then quickly release the tongue back into a neutral position. This repetitive tongue movement will be performed three times and values will be recorded.

    Measured: Changes from baseline to month 3

  3. Lingual endurance will be measured between the groups for a change from baseline to month 3

    The Iowa Oral Pressure Instrument device will measure the peak performance of maximum lingual endurance time by instructing the participant to place the bulb on the roof of the mouth and then apply and sustain pressure to the bulb for as long as he/she can at a threshold of 20% of the maximum anterior isometric pressure. The maximum lingual endurance time will also be recorded.

    Measured: Changes from baseline to month 3

  4. Voluntary cough function will be measured between the groups for a change from baseline to month 3

    Voluntary cough function will be assessed using an oral pneumotachograph, connected to a spirometer filter during voluntary cough production. The participant will be seated with a respiratory face-mask held in place by the examiner and instructed to complete three tidal breaths into the face-mask, airflow signal will be measured

    Measured: Changes from baseline to month 3

  5. Reflexive cough will be measured between the groups for a change from baseline to month 3

    Reflexive cough will be assessed using an oral pneumotachograph, differential pressure transducer, and have a side port with a one-way inspiratory valve for nebulizer connection. The nebulizer will deliver three randomized blocks of 0, 50, 100, 200, and 500 μM capsaicin.

    Measured: Changes from baseline to month 3

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Mar 2016 (estimated)
  2. Study startApr 2016
  3. Primary completion30 Nov 2017
  4. Study completion7 Feb 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02710110
Sponsor's protocol ID
IRB201501172
Status last verified
Jan 2020
First submitted
26 Feb 2016
Last updated
27 Jan 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing PowerLung trainer, Micro Mouth Pressure Meter and Pulmonary Function Testing in people with Amyotrophic Lateral Sclerosis, run by University of Florida at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Jan 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Maximum Expiratory Pressure will be measured between the groups for a change from baseline to month 3 (time frame: Changes from baseline to month 3). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jan 2020.

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