Pediatric Asthma Controller Trial (PACT)

NCT ID: NCT00272506

Last Updated: 2016-07-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Study Classification: INTERVENTIONAL
• Study Start Date: 2002-08-31
• Study Completion Date: 2004-09-30

Brief Summary

To evaluate current and novel therapies and management strategies for children with asthma. The emphasis is on clinical trials that help identify optimal therapy for children with different asthma phenotypes, genotypes, and ethnic backgrounds and children at different developmental stages.

Detailed Description

BACKGROUND:

Asthma is a complex disease that often starts early in life. Exacerbations can be triggered by a number of agents such as allergens, respiratory infections, environmental tobacco smoke and pollutants, drugs, chemicals, exercise, cold air, infections and strong emotion making asthma therapy difficult and sometimes complicated. Multiple medications are often required to treat symptoms (bronchodilator agents such as beta-2 adrenergic agonists, theophylline, and anticholinergics), as well the underlying disease process (anti-inflammatory agents such as inhaled and systemic corticosteroids, cromolyn sodium and nedocromil; and leukotriene modifiers).

The prevalence of asthma is increasing in all age groups, but most particularly in children under the age of 18 years. In 1992, the prevalence of self-reported asthma among persons under 18 years of age was 7.2 percent, compared to 5.1 percent among all persons. The most rapid increase in asthma has occurred in children under 5 years old, with rates increasing over 160 percent over the past 15 years. Among all ages, over 450,000 hospitalizations, 5,000 deaths, and more than 100 million days of restricted activity are due to asthma every year. Yet the burden of asthma disproportionately affects children. For example, asthma hospitalization rates are highest among persons age 0-4 years, and have increased over 28 percent in the last 15 years; mortality rates increased faster among those aged 5 to-12 years than among those age 15-34 years and neither changes in disease coding nor improved recognition of asthma fully explain these increases. Nearly one third of children restrict their activities due to asthma, including participation in physical education and sports.

Despite major advances in understanding the etiology and pathophysiology of asthma and the development of new therapeutic modalities to control symptoms and prevent exacerbations, effective therapies are not widely used in the pediatric health care community. Further, the long term effects and side effects of asthma medications in children, especially children under the age of 12 years, are not well understood. Much remains to be learned about the impact of asthma therapy at different ages and at different points in the natural history of the asthma in altering the progression, chronicity, or severity of the disease.

There is an urgent need to rapidly evaluate new and existing therapeutic approaches for children with asthma, and to disseminate the findings to health care professionals, patients and the public. There are several reasons why a pediatric asthma clinical research network will accelerate clinical research and meet this need. The highly variable and sometimes complicated clinical manifestations of asthma often make it difficult to accumulate a large number of comparable patients in one center. Further, uniformity in treatment protocols may reduce the number of patients needed at each clinical center. Also, the network mechanism will help pool the necessary clinical expertise and administrative resources to facilitate the conduct of multiple and novel therapeutic trials in a timely, efficient manner. This, in turn, would promote rapid dissemination of research findings to health care professionals.

DESIGN NARRATIVE:

Pediatric Asthma Controller Trial (PACT) is a study to determine the comparative effectiveness of inhaled corticosteroid, a leukotriene receptor antagonist, or a combination medication of inhaled corticosteroid and long-acting beta2-agonist in children with mild asthma. The study addresses a critical question facing primary care physicians about the optimal choice for initiating daily long-term treatment in children. The primary study outcome is the percentage of days without asthma during the 12-month treatment period. Recruitment began in August, 2002. A total of 300 children were assigned to one of three active treatment arms for 12 months: active ICS; a combination of active ICS and salmeterol; or active montelukast (LTRA). Major outcomes on the follow-up of 277 children were presented in May, 2005 at the American Thoracic Society meeting.

The study completion date listed in this record was obtained from the "Completed Date" entered in the Query View Report System (QVR).

Conditions

Asthma; Lung Diseases

Study Design

• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT

Interventions

inhaled corticosteroid

Intervention Type: DRUG

long-acting beta2-agonist

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

Asthmatic children from birth to 18 years. Emphasis is placed on infants and young children through 5 years of age.

• Maximum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Childhood Asthma Research and Education Network

NETWORK

Sponsor Role: collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role: lead

Principal Investigators

Vernon Chinchilli

Role:

Milton S. Hershey Medical Center

Robert Lemanske

Role:

University of Wisconsin, Madison

Fernando Martinez

Role:

University of Arizona

Robert Strunk

Role:

Washington University School of Medicine

Stanley Szefler

Role:

National Jewish Health

Robert Zeiger

Role:

University of California, San Diego

Other Identifiers

351

Identifier Type: -

Identifier Source: org_study_id