Effect of Ipratropium on Acute Bronchitis in Subjects Without Underlying Lung Disease

This study has been completed.
Sponsor:
Information provided by:
Kaiser Permanente
ClinicalTrials.gov Identifier:
NCT00371527
First received: August 31, 2006
Last updated: October 16, 2008
Last verified: August 2006
  Purpose

ABSTRACT CONTEXT: Inappropriate antibiotic prescriptions for acute bronchitis is a major public health concern because of antibiotic resistance. Effective therapies for managing the symptoms of acute bronchitis are lacking, however.

OBJECTIVE: Determine if patients with acute bronchitis have better symptom control when treated with inhaled ipratropium.

DESIGN, SETTING, PARTICIPANTS: COUGH STOP was a randomized, double blind, placebo controlled trial comparing ipratropium with placebo in acute bronchitis. Subjects were referred by their primary care provider or from urgent care clinics at a single institution. Subjects had been diagnosed with acute bronchitis and had no significant co-morbidities.

INTERVENTION: Subjects received ipratropium or placebo inhalers, administering 2 puffs four times daily. A structured telephone interview took place 2, 4, and 8 days after enrollment. Medical records were reviewed at 60 days.

OUTCOME: The primary endpoint was improvement in cough symptomology; secondary endpoints included subsequent antibiotic prescriptions and "well being."


Condition Intervention
Bronchitis
Drug: ipratropium

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: Effect of Ipratropium on Acute Bronchitis in Subjects Without Underlying Lung Disease

Resource links provided by NLM:


Further study details as provided by Kaiser Permanente:

Primary Outcome Measures:
  • Improvement in cough symptomology

Secondary Outcome Measures:
  • Subsequent antibiotic prescriptions
  • Frequency of follow up visits for similar complaints in the subsequent two months
  • Sense of well being
  • Time away from work or usual activities.

Estimated Enrollment: 200
Study Start Date: October 2002
Estimated Study Completion Date: January 2004
  Hide Detailed Description

Detailed Description:

METHODS

COUGH STOP was an investigator-initiated study. We conducted a prospective, randomized, double blind, placebo controlled trial to test the hypothesis that ipratropium would improve cough symptoms in otherwise healthy subjects with acute bronchitis. Subjects were enrolled between October 9th 2002 and November 1 2003, and were included if they had a cough with or without sputum production for less than 30 days duration; were age 18 through 65; and were willing to follow up by phone for a brief interview at 2, 4, and 8 days after enrollment. Subjects were excluded if they had a history of COPD; asthma; or other lung disease; had localized lung findings on exam to suggest pneumonia or asthma; chest X-ray (if done) with evidence of pneumonia; purulent nasal discharge or other evidence of bacterial sinus infection; evidence of streptococcal pharyngitis; temperature greater than 101.5 in the preceding 72 hours; treatment of a respiratory tract infection in the last 30 days; pregnancy; breast feeding; actively trying to become pregnant; history of heart failure; history of renal failure or insufficiency with a creatinine greater than 2.0 mg/dl; history of psychiatric illness other than minor depression; currently incarcerated; or were unwilling to sign the consent form.

The study was reviewed and approved by the IRB for our facility, and approved by the FDA by way of an IND application. Subjects were either referred to one of the study investigators by a practicing physician or nurse practitioner at our facility, or were enrolled by a member of our team directly. Subjects were given a copy of the consent form, asked to review it and ask questions. Those who signed the consent form were randomly assigned to treatment with ipratropium or placebo metered dose inhaler (MDI). The assignment key was maintained by the pharmacy and by one of the investigators who had no interaction with the subjects or the data collection process. Subjects received training on how to use an MDI with a spacer device from a member of the study team. Subjects were instructed to take two puffs from the study MDI four times a day for the next 8 days. After the first 8 days they were instructed to use the study MDI on an as needed basis if they thought it was benefiting them.

During a structured enrollment interview subjects were asked the following questions: How long have you been coughing (number of days)? What other symptoms do you have? Are you producing sputum? Do you smoke? Are you coughing at night? If "Yes," is it interrupting your sleep? Have you stopped working/daily activities? Are you having fevers? If "Yes," how high are they? What over-the-counter medications are you using?

During the follow up telephone interviews, on days 2, 4, and 8 after enrollment, subjects were asked a similar but shorter set of questions: Are you still coughing? Is your cough better, worse, the same? Are you producing sputum? Is your sputum production better, worse, the same? Are you coughing at night? If "Yes," is it interrupting your sleep? Have you returned to work/daily activities? Has your sense of well being returned? Are you having fevers? If "Yes," how high are they? Are you having any side effects with the medication? If "Yes," what are they? Are you having any problems using your inhaler? If "Yes," please describe. What over-the-counter medications are you using? Subjects were not given any medical advice during the follow up interviews and were advised to address any medical questions with their primary care physician.

Medical records were reviewed after two months of enrollment for, frequency of return clinic visits, medication prescriptions, especially antibiotics, and complications related to study enrollment. Subjects who had either a subsequent antibiotic prescription or clinic visit for respiratory complaints in the 60 days following study enrollment had an audit of their medical records. Subjects who were prescribed antibiotics in this period had their records reviewed for the following: which antibiotic was prescribed; how long after enrollment it was prescribed; and why it was prescribed. This data was collected in a separate database and reviewed in a blinded fashion by the entire research team for inclusion in the final analysis. All decisions were unanimous, and based on the following factors: the diagnosis at the time of the prescription was consistent with that of an upper respiratory tract infection (URI); the antibiotic prescribed was consistent with treatment for URI; in cases where the diagnosis at the time of prescription could not be determined, the subject was included in the secondary analysis if the antibiotic prescribed was consistent with treatment of a URI. Subjects were excluded from the analysis if their diagnosis at the time of the prescription was not consistent with URI or if the antibiotic prescribed was not consistent with treatment of a URI.

Similarly, subjects who had clinic visits in the subsequent sixty-days had their records audited. Data was again collected in a separate database and reviewed in a blinded fashion by the entire team. Again, all decisions were unanimous, and criteria for inclusion were that the diagnosis at the time of the visit was consistent with that of a URI.

Statistical Analysis Power analysis indicated that a sample size of approximately 100 subjects in the treatment and control arms would be sufficient to detect a 33% reduction of cough frequency in the experimental arm receiving ipratropium, assuming a =.05 and b =.20, using a two- tailed z-statistic. Calculation of standard effect size for this power analysis was based upon extrapolation from Hueston's and Melbye's data13 15 on albuterol and fenoterol use in acute bronchitis, assuming a similar effect of ipratropium. Effect size for this calculation was based upon published values of relative risk in the references. Power analysis was not performed for other outcome variables.

Data was analyzed on an intention-to-treat basis, according to randomized assignment. The ipratropium and placebo arms were compared for: self-reported cough severity [same, better, worse]; cough duration [present, not present] for days 2, 4, 8; , well-being [well, not-well] for days 2, 4, 8; work absence [attended work, did not work] for days 2, 4, 8. Proportions and rates for non-continuous grouped variables were compared using chi-square test. Normally distributed continuous variables, such as cough duration, were compared between treatment arms using a two-tailed t-test.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • cough with or without sputum production for less than 30 days duration; were age 18 through 65; and were willing to follow up by phone for a brief interview at 2, 4, and 8 days after enrollment

Exclusion Criteria:

  • history of COPD; asthma; or other lung disease; had localized lung findings on exam to suggest pneumonia or asthma; chest X-ray (if done) with evidence of pneumonia; purulent nasal discharge or other evidence of bacterial sinus infection; evidence of streptococcal pharyngitis; temperature greater than 101.5 in the preceding 72 hours; treatment of a respiratory tract infection in the last 30 days; pregnancy; breast feeding; actively trying to become pregnant; history of heart failure; history of renal failure or insufficiency with a creatinine greater than 2.0 mg/dl; history of psychiatric illness other than minor depression; currently incarcerated; or were unwilling to sign the consent form.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00371527

Locations
United States, California
South Sacramento Kaiser Permanente
Sacramento, California, United States, 95823
Sponsors and Collaborators
Kaiser Permanente
Investigators
Principal Investigator: Thomas B McIlraith, MD Mercy Medical Group
Principal Investigator: Norman Chow, MD Kaiser Permanente
  More Information

No publications provided

ClinicalTrials.gov Identifier: NCT00371527     History of Changes
Other Study ID Numbers: CN 01TMcIl 01 B, CN 01TMcIl 01 B
Study First Received: August 31, 2006
Last Updated: October 16, 2008
Health Authority: United States: Institutional Review Board

Keywords provided by Kaiser Permanente:
Bronchitis
Acute bronchitis
Ipratropium
Cough
Metered dose inhaler
Antibiotic prescriptions
Sputum production

Additional relevant MeSH terms:
Bronchitis
Acute Disease
Lung Diseases
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Respiratory Tract Infections
Disease Attributes
Pathologic Processes
Ipratropium
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Pharmacologic Actions
Anti-Asthmatic Agents
Respiratory System Agents
Therapeutic Uses
Cholinergic Antagonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 28, 2014