Effectiveness and Cost Study Comparing Two Ways to Deliver Albuterol for the Treatment of Asthma in the Hospital
|
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| ClinicalTrials.gov Identifier: NCT00623688 |
|
Recruitment Status :
Completed
First Posted : February 26, 2008
Last Update Posted : January 14, 2015
|
- Study Details
- Tabular View
- No Results Posted
- Disclaimer
- How to Read a Study Record
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Status Asthmaticus | Device: Metered Dose Inhaler & Optichamber Advantage Valve Holding Chamber (VHC) Device: Airlife Sidestream High Efficiency Nebulizer | Not Applicable |
Hide Detailed Description
Studies looking at the use of beta-2-agonists given by MDIs with a spacer and mask in children greater than 2 years have described fewer side effects than when the same medications are given as nebulizers. Patients have less tachycardia, vomiting, and oxygen desaturation (Kerem et al. 1993, Chou, Cunningham and Crain 1995, Lin and Hsieh 1995, Pendergast et al. 1989, Fuglsang and Pedersen 1986).
In the emergency department setting, Rubilar et. al found that albuterol delivered by MDI with spacer and mask had equal efficacy to albuterol delivered by a nebulizer in treating acute wheezing in children less than 2 years of age. (Rubilar, Castro-Rodriguez and Girardi 2000) Chou et. al found that in children greater than 2 years old with acute asthma exacerbations, MDIs had the same efficacy as nebulizers but with a shorter delivery time and fewer side effects.(Chou et al. 1995)
All children who meet criteria to be participants in the study will be approached for possible study enrollment in the ED. No outside recruiting will be done. Once consent has been obtained and patients are enrolled, they will be randomized to either albuterol by MDI with placebo nebulizer treatments or albuterol by nebulizer with placebo MDI treatments. Subjects will be randomized to one of the two treatment arms in a 1:1 randomization process. This will be done using a prepared assignment log developed using a random number generator.
Children in the control arm will receive albuterol via nebulizer and placebo by MDI with spacer +/- mask. Children in the experimental arm will receive albuterol by MDI and placebo by nebulizer.
All MDI treatments will be given with a spacer +/- mask. Subjects will receive 6 puffs if they are < 30 kg and 10 puffs if they are > 30 kg. If they are in the control group, puffs will be placebo. If they are in the experimental group, puffs will be albuterol (90 micrograms per puff).
For the nebulizer treatments, patients in the control group will receive 2.5 mg albuterol (if <30 kg) or 5 mg of albuterol (if 30 kg or greater) in 3 ml of normal saline. Patients in the experimental group will receive nebulizer treatments as 3 ml of normal saline. Nebulized treatments will be delivered with room air unless the subjects are on oxygen.
All study medication will be administered by clinical nursing staff or respiratory therapists. The frequency at which albuterol is given will be determined by the subject's primary medical team. For all subjects, MDI treatments will be given first followed by nebulizer treatments.
Nursing staff will record a Clinical Asthma Score (CAS) (Parkin et. al 1996) on admission and every 4 hours during hospitalization up to 72 hours or discharge (whichever comes first). Nursing staff will also record the total number of albuterol treatments given and the time required to give each treatment. Patients' total length of stay will be calculated. A cost analysis will be done to determine if there are any differences in the costs to the hospital of the two delivery devices. This analysis will include the costs of the albuterol and delivery devices and the labor costs related to nursing or respiratory therapists' time to administer the medications. Information on subjects' baseline level of asthma severity will also be collected at the beginning of the study.
All study patients will be given prednisolone, prednisone or solumedrol at a dose of 1 mg/kg/dose twice a day for a total of 5 days. The length of steroid treatment can be extended beyond 5 days if felt to be clinically indicated by the subject's attending physician.
Controller medications such as long acting beta-2-agonists, inhaled corticosteroids, and leukotriene inhibitors will be given at the discretion of the subject's in patient attending. All controller medications used before and during hospitalization will be recorded as part of the study data.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 11 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Treatment |
| Official Title: | Effectiveness and Costs of Albuterol Delivered by MDI With Spacer Versus Nebulizer in Children Hospitalized With Moderate and Severe Asthma Exacerbations |
| Study Start Date : | February 2008 |
| Actual Primary Completion Date : | April 2012 |
| Actual Study Completion Date : | April 2012 |
| Arm | Intervention/treatment |
|---|---|
|
Experimental: 1
Subjects receive active medication (albuterol) delivered by a Proair metered dose inhaler used with an Opti-chamber and placebo (normal saline solution) by nebulizer aerosol.
|
Device: Metered Dose Inhaler & Optichamber Advantage Valve Holding Chamber (VHC)
Albuterol is delivered by metered dose inhaler with valved holding chamber. For children less than 6 years of age, a mask is also used. |
|
Active Comparator: 2
Subjects receive active medication (albuterol) delivered by nebulizer and placebo (no medicine) delivered by a demonstrator Placebo metered dose inhaler demonstrator.
|
Device: Airlife Sidestream High Efficiency Nebulizer
Albuterol is delivered as a mist mixed with normal saline using a nebulizer machine and face mask or mouth piece. |
- Change in Clinical Asthma Severity score over time [ Time Frame: 72 hours ]
- Time to discharge [ Time Frame: Total time in the hospital ]
- Time to when are able to go 4 hours between albuterol treatments [ Time Frame: Time in hospital ]
- Cost of delivering albuterol by MDI versus nebulizer [ Time Frame: Time in hospital ]
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, Learn About Clinical Studies.
| Ages Eligible for Study: | 12 Months to 18 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Children 1 to 18 years of age with a known history of asthma being admitted to Akron Children's Hospital general medical floor for the treatment of moderate to severe asthma exacerbations
Exclusion Criteria:
- Children who have a concurrent pneumonia or bronchiolitis (diagnosed clinically or by chest x-ray)
- Have a diagnosis of chronic lung disease (ex. cystic fibrosis, bronchopulmonary dysplasia, chronic aspiration)
- Have cyanotic congenital heart disease, a congenital anomaly of the respiratory tract, or who are tracheostomy or ventilator dependent.
- Children who are determined by the Emergency Department (ED) or general pediatrics service to need ICU level care on admission will also be excluded.
- Children will also be excluded if their legal guardian does not speak English as all consent forms will be written and reviewed with guardians in English.
- Children will also be excluded if their legal guardians disagree on consent to participate, or if a child 9 years or older and their legal guardians disagree on study participation.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00623688
| United States, Ohio | |
| Akron Children's Hospital | |
| Akron, Ohio, United States, 44308-1062 | |
| Principal Investigator: | Kimberly A Spoonhower, M.D. | Akron Children's Hospital |
Publications:
| Responsible Party: | Akron Children's Hospital |
| ClinicalTrials.gov Identifier: | NCT00623688 History of Changes |
| Other Study ID Numbers: |
070908 |
| First Posted: | February 26, 2008 Key Record Dates |
| Last Update Posted: | January 14, 2015 |
| Last Verified: | January 2015 |
Keywords provided by Akron Children's Hospital:
|
Metered Dose Inhalers Nebulizers Randomized Controlled Trial |
Additional relevant MeSH terms:
|
Status Asthmaticus Asthma Bronchial Diseases Respiratory Tract Diseases Respiratory Hypersensitivity Hypersensitivity, Immediate Hypersensitivity Immune System Diseases Albuterol Bronchodilator Agents Autonomic Agents Peripheral Nervous System Agents |
Physiological Effects of Drugs Anti-Asthmatic Agents Respiratory System Agents Tocolytic Agents Reproductive Control Agents Adrenergic beta-2 Receptor Agonists Adrenergic beta-Agonists Adrenergic Agonists Adrenergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action |