LTOT in COPD Patients With Moderate Chronic Hypoxemia and Chronic Heart Failure

NCT ID: NCT00668408

Last Updated: 2009-08-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-05-31

Study Completion Date

2012-10-31

Brief Summary

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In patients with both COPD and CHF, moderate chronic hypoxemia is caused by a combination of intrapulmonary and extrapulmonary factors. The hypothesis of this study is that adequate medical therapy for both conditions can correct the moderate hypoxemia by improving the underlying mechanisms without the need of LTOT. If this hypothesis is correct, the study will provide a valuable information to the Italian Agency of drugs (Agenzia Italiana del Farmaco, AIFA) to reduce the inappropriate use of LTOT for COPD patients with moderate hypoxemia and CHF, and will help the Italian National Health Service to reduce both the direct and indirect costs of unnecessary LTOT.

Detailed Description

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Long-term oxygen treatment (LTOT) improves survival of COPD patients with severe hypoxemia . The improved survival was proven in COPD patients with severe chronic hypoxemia (PaO2\< or = 55 mmHg), providing oxygen was delivered for = or \>15 hours/day. Since then, \> 15 hours/day LTOT has become the standard treatment for COPD patients with severe hypoxemia. LTOT has been extended without evidence to COPD patients with moderate hypoxemia (55\< PaO2 \<60mmHg), when associated with some clinical and laboratory signs of cardiac diseases and to patients with decreased oxygen saturation (SO2 \< 90%) during exercise or sleep. Chronic heart failure (CHF) is a common co-morbidity of COPD (\>30% ) particularly in the elderly. Whether LTOT improves survival in patients with moderate chronic hypoxemia and CHF is unknown. This is an issue of concern because of the potential importance of LTOT in severe COPD, and of the cost of LTOT (about Euro 250 millions/year in Italy). The aim of this 3 year randomized clinical trial is to investigate whether, in COPD patients with moderate hypoxemia associated with CHF treatment including LTOT is no different from treatment without LTOT in term of survival and of exacerbations, hospitalizations, and quality of life. The study will be conducted in 76 Italian hospital pulmonary units, and will start on May 15th 2008 and end on October 31st 2012. One thousand stable COPD patients treated according to COPD and CHF international guidelines will be randomized to treatment including LTOT (Study Group) or treatment without LTOT (Control Group). All patients will regularly undergo clinical assessment, arterial blood gases (3 monthly), and Saint George's Respiratory Questionnaire (SGRQ, 6 monthly),and will be contacted with monthly telephone calls.

Considering 1) the lack of evidence supporting LTOT in COPD patients with moderate hypoxemia and CHF, 2) the pathophysiology of CHF , and 3) the improvement of pharmacological treatment of both COPD and CHF, we expect that, after optimization of medical therapy, LTOT will not improve survival or frequency and severity of exacerbations and/or hospitalization, and not even quality of life due to the balance of small clinical benefits (improved exercise tolerance, better sleep) with the inconveniences associated with LTOT. This non-inferiority study is powered on survival, which is the primary outcome of the study.

Conditions

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Lung Diseases, Obstructive Chronic Heart Failure Chronic Hypoxemia

Keywords

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OTLT COPD CHRONIC HYPOXEMIA CHF

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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LTOT group

Study group: optimal medical therapy plus LTOT = or \> 15 hours pro die

Group Type OTHER

LTOT (oxygen therapy)

Intervention Type OTHER

Patients on LTOT will receive oxygen for at least 15 hours/day from the liquid oxygen systems at a flow rate adjusted to raise resting SaO2 between 93 and 96% and / or PaO2 between 65 and 80 mmHg every day for 3 years.

Non LTOT group

control group: optimal medical therapy without LTOT

Group Type OTHER

Pharmacological therapy of COPD and CHF

Intervention Type OTHER

Optimal pharmacologic treatment will include :

* Long (LABD, salmeterol, formoterol, tiotropium) - as well as short-acting (SABD, Salbutamol, terbutaline, ipratropium)bronchodilators (beta-2 agonists, anticholinergics)
* Inhaled steroids (ICS, beclomethasone, fluticasone, budesonide always associated with LABD)
* Beta-blockers
* Diuretics
* Angiotensin-converting enzyme (ACE) inhibitors alone or in associations with diuretics
* Statins and any other treatment required for associated co-morbidities (eg insulin and/or anti-diabetic drugs, other antihypertensive, etc).

The treatment of the deseases will follow the international guidelines.

Interventions

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LTOT (oxygen therapy)

Patients on LTOT will receive oxygen for at least 15 hours/day from the liquid oxygen systems at a flow rate adjusted to raise resting SaO2 between 93 and 96% and / or PaO2 between 65 and 80 mmHg every day for 3 years.

Intervention Type OTHER

Pharmacological therapy of COPD and CHF

Optimal pharmacologic treatment will include :

* Long (LABD, salmeterol, formoterol, tiotropium) - as well as short-acting (SABD, Salbutamol, terbutaline, ipratropium)bronchodilators (beta-2 agonists, anticholinergics)
* Inhaled steroids (ICS, beclomethasone, fluticasone, budesonide always associated with LABD)
* Beta-blockers
* Diuretics
* Angiotensin-converting enzyme (ACE) inhibitors alone or in associations with diuretics
* Statins and any other treatment required for associated co-morbidities (eg insulin and/or anti-diabetic drugs, other antihypertensive, etc).

The treatment of the deseases will follow the international guidelines.

Intervention Type OTHER

Other Intervention Names

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LTOT treatment Pharmacological treatment

Eligibility Criteria

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Inclusion Criteria

* Age 40 \> 80 years
* Confirmed COPD (GOLD criteria)
* Moderate and stable hypoxemia (55\< PaO2 \<65 mmHg)
* Clinical signs of CHF (ESC criteria)
* Ex-smokers (\> 20 pack/years) since at least 3 months

Exclusion Criteria

* Clinical instability and/or exacerbation
* Congenital heart diseases
* Lung cancer
* Thoracic restrictive disorders
* Other coexisting diseases influencing 3-yr survival
Minimum Eligible Age

40 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Modena and Reggio Emilia

OTHER

Sponsor Role collaborator

Azienda Ospedaliero-Universitaria Careggi

OTHER

Sponsor Role lead

Responsible Party

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Azienda Ospedaliero-Universitaria Careggi Firenze (UTIP)

Principal Investigators

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Antonio Corrado, MD

Role: PRINCIPAL_INVESTIGATOR

AOU Careggi

Locations

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Ausl 8 di Arezzo

Arezzo, AR, Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera S. G. Moscati

Avellino, AV, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Ospedale consorziale policlinico di Bari

Bari, BA, Italy

Site Status RECRUITING

Presidio ospedaliero Barletta

Barletta, BA, Italy

Site Status RECRUITING

Azienda ospedale G. Rummo

Benevento, BN, Italy

Site Status ACTIVE_NOT_RECRUITING

Irccs Fondazione Maugeri

Gussago, BS, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale Roberto Binaghi

Cagliari, CA, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio Ospedaliero F.lli Crobu Iglesias

Iglesias, CI, Italy

Site Status ACTIVE_NOT_RECRUITING

Asp di Cosenza - Ambito territoriale di Castrovillari (ex asl 2)

Castrovillari, CS, Italy

Site Status ACTIVE_NOT_RECRUITING

Asp di Catanzaro - Ambito territoriale di catanzaro (ex asl 7)

Catanzaro, CZ, Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera Mater Domini

Catanzaro, CZ, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio Ospedaliero Morgagni-Pierantoni di Forlì

Forlì, FC, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio Ospedaliero Morgagni-Pierantoni

Forlì, FC, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Arcispedale S. Anna

Ferrara, FE, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Careggi

Florence, FI, Italy

Site Status RECRUITING

Irccs fondazione Don Gnocchi - Centro S. Maria agli ulivi

Impruneta, FI, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria S. Martino

Genova, GE, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale della Misericordia

Grosseto, GR, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale S. Andrea

Massa Marittima, GR, Italy

Site Status ACTIVE_NOT_RECRUITING

Stabilimento ospedaliero di Imperia

Imperia, IM, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale generale prov. card. G. Panico

Tricase, LE, Italy

Site Status ACTIVE_NOT_RECRUITING

Ausl 2 di Lucca

Lucca, LU, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale S. Giuseppe f.b.f.

Milan, MI, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale civile di Vimercate

Vimercate, MI, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio Ospedaliero C. Poma

Mantova, MN, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria policlinico di Modena

Modena, MO, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale Civile di Carrara

Carrara, MS, Italy

Site Status RECRUITING

A.O. V. Cervello

Palermo, PA, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio ospedaliero Civico e benfratelli

Palermo, PA, Italy

Site Status ACTIVE_NOT_RECRUITING

Aulss 15 alta padovana

Cittadella, PD, Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera di padova

Padua, PD, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. di Perugia - Ospedale S. Maria della Misericordia (ex Silvestrini)

Perugia, PG, Italy

Site Status ACTIVE_NOT_RECRUITING

Asl 2 di Perugia

Perugia, PG, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Pisana

Pisa, PI, Italy

Site Status RECRUITING

Azienda Ospedaliera S. Maria degli angeli

Pordenone, PN, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria di Parma

Parma, PR, Italy

Site Status ACTIVE_NOT_RECRUITING

Ausl 3 di Pistoia

Pistoia, PT, Italy

Site Status ACTIVE_NOT_RECRUITING

Irccs fondazione Maugeri

Montescano, PV, Italy

Site Status ACTIVE_NOT_RECRUITING

Irccs Fondazione Maugeri

Pavia, PV, Italy

Site Status RECRUITING

Irccs policlinico S. Matteo

Pavia, PV, Italy

Site Status RECRUITING

Ospedale S. Sebastiano

Correggio, RE, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale di S. Maria Nuova

Reggio Emilia, RE, Italy

Site Status RECRUITING

Ospedale S. Camillo De Lellis

Rieti, RI, Italy

Site Status ACTIVE_NOT_RECRUITING

Ausl rm/h di Albano Laziale

Albano Laziale, RM, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Policlinico Tor Vergata

Roma, RM, Italy

Site Status ACTIVE_NOT_RECRUITING

Az. Osp. San Camillo-Forlanini

Roma, RM, Italy

Site Status ACTIVE_NOT_RECRUITING

Az.osp.san camillo-forlanini -

Roma, RM, Italy

Site Status ACTIVE_NOT_RECRUITING

Aulss 18 di Rovigo

Rovigo, RO, Italy

Site Status ACTIVE_NOT_RECRUITING

Asl sa/2 di Salerno

Salerno, SA, Italy

Site Status RECRUITING

A.O. Universitaria senese

Siena, SI, Italy

Site Status ACTIVE_NOT_RECRUITING

Presidio ospedaliero San Bartolomeo

Sarzana, SP, Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera Umberto I

Syracuse, SR, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Policlinico di Sassari

Sassari, SS, Italy

Site Status ACTIVE_NOT_RECRUITING

Az. Osp. Ospedale S. Corona

Pietra Ligure, SV, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale Mazzini

Teramo, TE, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale di Trento - P.O. S.Chiara

Trento, TN, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria S. Giovanni Battista-Molinette di Torino

Torino, TO, Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria ospedali riuniti di Trieste

Trieste, TS, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale di

Vicenza, VI, Italy

Site Status ACTIVE_NOT_RECRUITING

Ospedale civile Orlandi Bussolengo

Bussolengo, VR, Italy

Site Status ACTIVE_NOT_RECRUITING

Terapia Intensiva Pneumologica- AOU Careggi

Florence, , Italy

Site Status RECRUITING

Azienda ospedaliera "A. Cardarelli"

Napoli, , Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera Antonio Cardarelli di Napoli

Napoli, , Italy

Site Status ACTIVE_NOT_RECRUITING

Azienda Ospedaliera Cotugno

Napoli, , Italy

Site Status ACTIVE_NOT_RECRUITING

A.O. Universitaria Maggiore della Carità

Novara, , Italy

Site Status ACTIVE_NOT_RECRUITING

Irccs Fondazione Maugeri

Veruno, , Italy

Site Status ACTIVE_NOT_RECRUITING

Countries

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Italy

Central Contacts

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Antonio Corrado, MD

Role: CONTACT

Phone: 39-055-794-6559

Email: [email protected]

Teresa Renda, MD, PhD

Role: CONTACT

Phone: 39-328-977-9239

Email: [email protected]

Facility Contacts

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Antonio Corrado, MD

Role: primary

Teresa Renda, MD

Role: backup

Other Identifiers

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FARM6YHYW4

Identifier Type: -

Identifier Source: org_study_id