Effects of Bronchodilation on Computed Tomography (CT) Parameters Reflecting Airways Remodelling, and Pulmonary Emphysema Extent.
NCT ID: NCT01142531
Last Updated: 2012-07-04
Study Results
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Basic Information
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COMPLETED
20 participants
OBSERVATIONAL
2010-03-31
2011-06-30
Brief Summary
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This is a prospective study whose purpose is to assess the effect of bronchodilation on lung CT scan and pulmonary function testing (PFT) in COPD patients.
Detailed Description
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Procedures:
At Visit 1, after obtaining the written informed consent of the patient, medical history, smoking status and patient's treatment will be collected. They will be asked to discontinue bronchodilator therapies as follows, such that pulmonary function tests (PFT) and CT scan will be initially evaluated in a medication wash-out period at Visit 2:
* Short acting a2 agonists and anticholinergics: 8 wash-out
* Long acting a2 agonists: 12h wash-out
* Long acting anticholinergics: 48h wash-out
* Theophylline preparations: 48h wash-out
* Antileucotrienes: 48h wash-out
At visit 2, PFT will be performed, including vital capacity (VC), forced vital capacity (FVC), functional residual capacity (FRC), total lung capacity (TLC), residual volume (RV), forced expiratory volume in one second (FEV1), diffusion lung capacity for carbon monoxide (DLCO), and alveolar volume (VA) measurements (either in absolute values and percentage of predicted values). A first CT scan will be performed using the following technique:
* Supine CT scan after full inspiration.
* Acquisition parameters: (Topogram 35 mA 120 kV 512 mm length) 90 quality ref mAs with care-dose ON 120 kV Pitch 1.4 Rotation time 0.33 s Acquired images 64 x 0.6 mm
* Reconstructions parameters:
B60f 1mm-thick every 0.7 mm B20f 1mm-thick every 10.0 mm B35f 1mm-thick every 0.7 mm B60f 5mm-thick every 5.0 mm B35f 5mm-thick every 5.0 mm
After the initial PFT and CT scan, the patient will receive 80 µg of ipratropium bromide(= 4X20µg Atrovent, via Metered-Dose Inhaler + spacer, 30 seconds between each dose) and 60 minutes later, 400 µg salbutamol (=4X100 µg Ventolin).
A second PFT will be performed 30 min after salbutamol inhalation, followed by a second CT Scan.
Data analysis:
* Emphysema index: from B20f reconstructions, calculation of RA960 using Pulmo CT software.
* Airway index: from B60f reconstructions (1mm-thick every 0.7 mm), calculations of luminal area and wall area for several bronchi.
Statistical analyses : Comparisons of CT parameters values or derived values (for example : wall area to airway area ratio) reflecting emphysema and airways remodelling, before and after bronchodilation. Correlations with PFT values and derived values.
Conditions
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Study Design
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CASE_ONLY
PROSPECTIVE
Study Groups
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COPD
COPD patients aged 40 or more, with a smoking history of \> 10 PY and a post-bronchodilator FEV1/VC \< 0.7 will be included. Exclusion criteria are: COPD exacerbation or respiratory infection in the 4 weeks before the begin of the study, concomitant pulmonary disease (tuberculosis, significant bronchiectasis, lung cancer), pulmonary resection, active malignancy or malignancy of any organ system within the past 5y.
Chest CT scan
Supine CT scan after full inspiration. Acquisition parameters: (Topogram 35 mA 120 kV 512 mm length)
* 90 quality ref mAs with care-dose ON
* 120 kV
* Pitch 1.4
* Rotation time 0.33 s
* Acquired images 64 x 0.6 mm
Interventions
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Chest CT scan
Supine CT scan after full inspiration. Acquisition parameters: (Topogram 35 mA 120 kV 512 mm length)
* 90 quality ref mAs with care-dose ON
* 120 kV
* Pitch 1.4
* Rotation time 0.33 s
* Acquired images 64 x 0.6 mm
Eligibility Criteria
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Inclusion Criteria
* Smoking history \> 10 pack-years
* post bronchodilator FEV1/VC \< 0.7
Exclusion Criteria
* Concomitant pulmonary disease (tuberculosis, significant bronchiectasis, lung cancer)
* pulmonary resection
* active malignancy or malignancy of any organ system within the past 5 years
18 Years
ALL
No
Sponsors
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Centre Hospitalier Universitaire Saint Pierre
OTHER
Erasme University Hospital
OTHER
Responsible Party
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Maxime HACKX
Maxime HACKX, MD
Principal Investigators
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Pierre Alain GEVENOIS, MD, PhD
Role: STUDY_DIRECTOR
Erasme University Hospital
Locations
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C.H.U Saint-Pierre
Brussels, , Belgium
Countries
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References
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Nakano Y, Muro S, Sakai H, Hirai T, Chin K, Tsukino M, Nishimura K, Itoh H, Pare PD, Hogg JC, Mishima M. Computed tomographic measurements of airway dimensions and emphysema in smokers. Correlation with lung function. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):1102-8. doi: 10.1164/ajrccm.162.3.9907120.
Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, Ito Y, Betsuyaku T, Nishimura M. Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2006 Jun 15;173(12):1309-15. doi: 10.1164/rccm.200601-037OC. Epub 2006 Mar 23.
Patel BD, Coxson HO, Pillai SG, Agusti AG, Calverley PM, Donner CF, Make BJ, Muller NL, Rennard SI, Vestbo J, Wouters EF, Hiorns MP, Nakano Y, Camp PG, Nasute Fauerbach PV, Screaton NJ, Campbell EJ, Anderson WH, Pare PD, Levy RD, Lake SL, Silverman EK, Lomas DA; International COPD Genetics Network. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008 Sep 1;178(5):500-5. doi: 10.1164/rccm.200801-059OC. Epub 2008 Jun 19.
Duranti R, Filippelli M, Bianchi R, Romagnoli I, Pellegrino R, Brusasco V, Scano G. Inspiratory capacity and decrease in lung hyperinflation with albuterol in COPD. Chest. 2002 Dec;122(6):2009-14. doi: 10.1378/chest.122.6.2009.
Pellegrino R, Brusasco V. On the causes of lung hyperinflation during bronchoconstriction. Eur Respir J. 1997 Feb;10(2):468-75. doi: 10.1183/09031936.97.10020468.
Stanescu DC, Rodenstein D, Cauberghs M, Van de Woestijne KP. Failure of body plethysmography in bronchial asthma. J Appl Physiol Respir Environ Exerc Physiol. 1982 Apr;52(4):939-48. doi: 10.1152/jappl.1982.52.4.939.
Berger P, Perot V, Desbarats P, Tunon-de-Lara JM, Marthan R, Laurent F. Airway wall thickness in cigarette smokers: quantitative thin-section CT assessment. Radiology. 2005 Jun;235(3):1055-64. doi: 10.1148/radiol.2353040121. Epub 2005 Apr 15.
Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Pistolesi M, Villari N, Mascalchi M. Chronic obstructive pulmonary disease: thin-section CT measurement of airway wall thickness and lung attenuation. Radiology. 2005 Feb;234(2):604-10. doi: 10.1148/radiol.2342040013.
Hackx M, Gyssels E, Severo Garcia T, De Meulder I, Alard S, Bruyneel M, Van Muylem A, Ninane V, Gevenois PA. Chronic Obstructive Pulmonary Disease: CT Quantification of Airway Dimensions, Numbers of Airways to Measure, and Effect of Bronchodilation. Radiology. 2015 Dec;277(3):853-62. doi: 10.1148/radiol.2015140949. Epub 2015 May 19.
Other Identifiers
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AK/10-02-13/3862
Identifier Type: -
Identifier Source: org_study_id