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Cystic FibrosisNCT02721498

Improving Outcome Measures For Adult CF ACT Trials

A study testing Airway clearance session using the Active Cycle of Breathing Techniques (ACBT) and Rest period in people with Cystic Fibrosis, run by Royal Brompton & Harefield NHS Foundation Trust at 1 site in United Kingdom.

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

This is a randomised controlled cross-over trial involving adult cystic fibrosis (CF) patients from the Royal Brompton Hospital, London investigating outcome measures used in airway clearance trials. Each participant will attend the research facility for two visits. Read more about this study

Who is it for?
Ages 16 years and older
Conditions the study is for
Cystic Fibrosis
What is being tested?
Airway clearance session using the Active Cycle of Breathing Techniques (ACBT) and Rest period
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
68 participants
Where
1 siteUnited Kingdom
Study dates
Sep 2016to Dec 2021
Phase
Interventional
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 16 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Diagnosis of CF (confirmed by standard criteria)
  • Sixteen years of age or over
  • Patients in a stable state (characterised by no required therapy changes within 28 days of visit and patient symptoms)

Who cannot join

  • Current infective exacerbation or reduction in lung function requiring therapeutic intervention
  • Current moderate haemoptysis (greater than streaking in the sputum)
  • Current dependency on positive pressure support with ACT
  • Previous history of spontaneous rib fractures
  • Pregnancy
  • Inability to give consent for treatment or measurement
Show all 9Show fewer
  • Current participation in another interventional study
  • Current dependency upon non-invasive ventilation
  • Current dependency upon oxygen therapy

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • The Royal Brompton Hospital

    London, Greater London, SW3 6NP

Other trials in United Kingdom

About this study

Official title: Improving Outcome Measures For Physiotherapy Trials of Airway Clearance in Adults With Cystic Fibrosis

This is a randomised controlled cross-over trial involving adult cystic fibrosis (CF) patients from the Royal Brompton Hospital, London investigating outcome measures used in airway clearance trials.

Each participant will attend the research facility for two visits. Participants will be randomly assigned to the order that they perform the study sessions. Visit A will involve a period of rest for up to 60 minutes in-between assessments; Visit B will involve a session of airway clearance (ACT) utilising ACBT supervised by a specialist physiotherapist in adult CF.

Read more

Participants will perform the outcome measure (OM) tests of impulse oscillation system (IOS), lung clearance index (LCI), and spirometry, then either rest (visit A) or perform a supervised ACBT session (visit B) using electronic impedance tomography (EIT) during the session. IOS, LCI and spirometry will be repeated after the session. Sputum will be collected throughout the ACT or rest sessions and for 30 minutes after each of these sessions is completed. Questionnaires asking patient views on the OMs will be completed at the end of each study visit.

Analysis will be based upon differences in outcome measures and in-between study days.

Read the detailed description

Research Question: Does the use of a new assessment tool box (Electronic Impedance Tomography (EIT), Lung Clearance Index (LCI), Impulse Oscillation System (IOS)) give results that are more sensitive to change for the effect of an airway clearance technique (ACT) (the Active Cycle of Breathing Techniques (ACBT)) while having low variability and good repeatability in stable adult patients with cystic fibrosis (CF) than the traditional gold standard outcome measures of forced expiratory volume in one second (FEV1) and sputum wet weight?

Hypothesis: The use of a new outcome assessment tool box will allow more sensitive information about the effects of ACTs in stable adult patients with CF than the current gold standard measures.

This is a randomised controlled cross-over trial involving adult cystic fibrosis (CF) patients from the Royal Brompton Hospital, London. Participants will be their own controls. Each participant will attend the research facility for two visits. Prior to starting the study assessment session participants will be questioned to ensure they are in a stable state of their disease (characterised by symptoms and having had no treatment changes for 28 days prior to the visit). All participants will continue with the timing and prescribed dosing of all inhaled medications as directed prior to the study. Subjects will be their own controls. Subjects will be randomly assigned to the order that they perform the study sessions. Visit A will involve a period of rest for up to 60 minutes in-between assessments; Visit B will involve a session of airway clearance (ACT) utilising the Active Cycle of Breathing Techniques (ACBT) supervised by a specialist physiotherapist in adult CF. The ACT session will last for thirty minutes minimum, to 60 minutes maximum until a consensus is reached between participant and physiotherapist that the participant's chest is clear.

Subjects will perform the OM tests of impulse oscillation system (IOS), lung clearance index (LCI), and spirometry, then either rest (visit A) or perform a supervised ACBT session (visit B) using electronic impedance tomography (EIT) during the session. IOS, LCI and spirometry will be repeated immediately after the session. Sputum will be collected throughout the ACT or rest sessions and for 30 minutes after each of these sessions is completed. Questionnaires asking patient views on the OMs will be given for completion after the last OM test is completed on each study visit.

There are no planned follow up measurements for participants in this study design.

All usual medications will be permitted for this study. Attention will be paid to mucoactive drugs (Pulmozyme®, Mannitol®, Hypertonic saline) to ensure the same frequency and dosing of inhalations for both study visits.

Data will be analysed in 3 groups based upon disease severity. Analysis will be based upon differences in outcome measures and in-between study days.

Conditions
Cystic Fibrosis
Being tested
Airway clearance session using the Active Cycle of Breathing Techniques (ACBT), Rest period
Keywords
Respiratory Physiotherapy, Airway clearance techniques, Outcome measures
Medical subject headings
Cystic Fibrosis

What participants receive

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

  • Airway clearance session using the Active Cycle of Breathing Techniques (ACBT)Procedure or surgery

    An airway clearance technique incorporating thoracic expansion exercises, breathing control (normal diaphragmatic breathing) and the forced expiration technique (or huffing)

  • Rest periodOther

    A 30-60 minute of resting

Study groups in NCT02721498
Study groupRoleWhat they receive
Visit AActive comparatorRest period for 30-60 minutes
Receives: Other: Rest period
Visit BActive comparatorAirway clearance session utilising the Active Cycle of Breathing techniques (ACBT) supervised by a specialist physiotherapist for 30-60 minutes.
Receives: Procedure: Airway clearance session using the Active Cycle of Breathing Techniques (ACBT)

What is being measured

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

  1. Change in Lung Clearance Index

    This is a technique which involves breathing quietly through a tube whilst wearing nose clips. The test measures harmless tracer gases which are breathed in and out and measured by a sensitive gas-detection system. The LCI is calculated based on how long it takes for the gas to be breathed out from the lungs, and it shows if there are areas within the lung that are working less efficiently than others, for example when areas of the lung are clogged with mucus.

    Measured: Immediately pre-intervention and immediately post-intervention

  2. Change in Forced Expiratory Volume in One Second

    A forced expiratory manoeuvre into a spirometer (value derived from 1 second blow)

    Measured: Immediately pre-intervention and immediately post-intervention

  3. Electronic Impedance Tomography

    This technique involves wearing a belt around the chest which has electrodes attached to it. Undetectable alternating electrical currents are then applied to the electrodes, which the participant will not be able to feel. The machine measures how easy or difficult it is for that current to travel through the lungs and any differences are calculated, giving a picture of the ventilation of the lung.

    Measured: During intervention

  4. Change in Impulse Oscillation System

    The Impulse Oscillation system is a non-invasive technique where the participant breathes normally through a mouthpiece whilst wearing a nose clip, into a machine which produces small pressure vibrations (oscillations). The machine measures these vibrations and any changes to them to give an idea of obstructions to the airways, for example any mucus clogging.

    Measured: Immediately pre-intervention and immediately post-intervention

  5. Sputum Wet Weight

    Amount of sputum expectorated will be measured in a pre-weighed pot

    Measured: During intervention and for 30 minutes post-intervention

Secondary outcomes (6)
  1. Change in Forced Vital Capacity

    A forced expiratory manoeuvre into a spirometer (value derived from full expiration)

    Measured: Immediately pre-intervention and immediately post-intervention

  2. Change in Forced Expiratory Flow at 25% of Forced Vital Capacity

    A forced expiratory manoeuvre into a spirometer (value derived from full expiration)

    Measured: Immediately pre-intervention and immediately post-intervention

  3. Change in Forced Expiratory Flow at 50% of Forced Vital Capacity

    A forced expiratory manoeuvre into a spirometer (value derived from full expiration)

    Measured: Immediately pre-intervention and immediately post-intervention

  4. Change in Forced Expiratory Flow at 75% of Forced Vital Capacity

    A forced expiratory manoeuvre into a spirometer (value derived from full expiration)

    Measured: Immediately pre-intervention and immediately post-intervention

  5. Oxygen saturation measurements

    Completed via a finger probe connected to a pulse oximeter which will record saturations over the whole session.

    Measured: During interventions

  6. Patient feedback questionnaire

    A patient reported outcome investigating the opinions of participants on each of the OMs completed during the trial using open and Likert scale questions

    Measured: Straight after the intervention

Timeline

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

  1. First posted29 Mar 2016 (estimated)
  2. Study startSep 2016
  3. Primary completionDec 2021
  4. Study completionDec 2021

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
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Masking
Single blind
Who is masked
Investigator
Enrolment
68 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02721498
Sponsor's protocol ID
2016CF001B
Status last verified
Dec 2021
First submitted
9 Mar 2016
Last updated
15 Dec 2021
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Kent L, Reix P, Innes JA, Zielen S, Le Bourgeois M, Braggion C, Lever S, Arets HG, Brownlee K, Bradley JM, Bayfield K, O'Neill K, Savi D, Bilton D, Lindblad A, Davies JC, Sermet I, De Boeck K; European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) Standardisation Committee. Lung clearance index: evidence for use in clinical trials in cystic fibrosis. J Cyst Fibros. 2014 Mar;13(2):123-38. doi: 10.1016/j.jcf.2013.09.005. Epub 2013 Dec 5.

    PubMed 24315208
  • Bradley JM, Moran FM, Elborn JS. Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: an overview of five Cochrane systematic reviews. Respir Med. 2006 Feb;100(2):191-201. doi: 10.1016/j.rmed.2005.11.028.

    PubMed 16412951
  • Osman LP, Roughton M, Hodson ME, Pryor JA. Short-term comparative study of high frequency chest wall oscillation and European airway clearance techniques in patients with cystic fibrosis. Thorax. 2010 Mar;65(3):196-200. doi: 10.1136/thx.2008.111492. Epub 2009 Aug 23.

    PubMed 19703826
  • Pfleger A, Steinbacher M, Schwantzer G, Weinhandl E, Wagner M, Eber E. Short-term effects of physiotherapy on ventilation inhomogeneity in cystic fibrosis patients with a wide range of lung disease severity. J Cyst Fibros. 2015 Sep;14(5):627-31. doi: 10.1016/j.jcf.2014.12.017. Epub 2015 Jan 19.

    PubMed 25612899
  • Wettstein M, Radlinger L, Riedel T. Effect of different breathing aids on ventilation distribution in adults with cystic fibrosis. PLoS One. 2014 Sep 15;9(9):e106591. doi: 10.1371/journal.pone.0106591. eCollection 2014.

    PubMed 25222606
  • Horsley A. 2009. 'Non-Invasive Assessment of Ventilation Maldistribution in Lung Disease Using Multiple Breath Inert Gas Washouts', University of Edinburgh, UK

  • Hurt, K. 2013. 'Small Airways Assessment In Adult Cystic Fibrosis', Imperial College (National Heart and Lung Institute), UK

  • Stanford G, Davies JC, Usmani O, Banya W, Charman S, Jones M, Simmonds NJ, Bilton D. Investigating outcome measures for assessing airway clearance techniques in adults with cystic fibrosis: protocol of a single-centre randomised controlled crossover trial. BMJ Open Respir Res. 2020 Oct;7(1):e000694. doi: 10.1136/bmjresp-2020-000694.

    PubMed 33020113

Questions about this trial

What is this clinical trial studying?

A study testing Airway clearance session using the Active Cycle of Breathing Techniques (ACBT) and Rest period in people with Cystic Fibrosis, run by Royal Brompton & Harefield NHS Foundation Trust at 1 site in United Kingdom.

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 3 inclusion and 9 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 15 Dec 2021. 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 Kingdom. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

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?

Change in Lung Clearance Index (time frame: Immediately pre-intervention and immediately post-intervention). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02721498, which also lists 8 linked publications.

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 15 Dec 2021.

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