Drug to Prevent Pneumonia in the Tube Fed

The Chinese University of Hong Kong

Status and phase: Terminated; Phase 4

Conditions: Neurological Dysphagia; Pneumonia

Treatments: Drug: Angiotensin converting enzyme inhibitor (Lisinopril); Drug: Placebo

Study type: Interventional

Funder types: Other

Identifiers

NCT02358642

ACEI-RCT

Details and patient eligibility

About

Background: Older people with neurological dysphagia are at risk of recurrent aspiration pneumonia. Angiotensin converting enzyme inhibitor (ACEI) has been shown to improve swallowing and cough reflexes which may protect dysphagic patients from aspiration pneumonia.

Hypotheses: ACEI reduces the risk of pneumonia in older patients who are nasogastric tube fed because of dysphagia from cerebrovascular diseases.

Design: Randomized placebo controlled trial

Method: 302 older patients who have been tube fed for more than two weeks because of dysphagia secondary to cerebrovascular diseases are randomized to take half of lisinopril 5 mg or placebo tablet once daily for 26 weeks. The subjects will be recruited from medical wards in Prince of Wales and Shatin Hospitals, and from outpatients of geriatric or speech therapy clinics, who have had hospital stay in previous three months. The subjects are followed up at week 12 and 26. The primary outcome is the incidence rate of pneumonia as determined by pneumonic change on X ray and clinical criteria. The secondary outcomes are mortality rate, total episodes of pneumonia over 26 weeks, and swallowing ability defined by the Royal Brisbane Hospital Outcome Measure at week 12. Cost effectiveness analysis of public health care and personal health care costs will be performed. Intention to treat and log rank will be used to analyzed the group differences in outcomes. 60 subjects (30 in each trial group) recruited from medical inpatients at Prince of Wales Hospital will undergo swallowing videofluoscopy at baseline and week 12 follow-up.

Enrollment: 93 patients

Sex: All

Ages: 60+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Tube fed for more than four weeks for reason of neurological dysphagia as recommended by a trained speech therapist;
• clinical diagnosis of cerebrovascular diseases, confirmed by CT head scan. The reason for restricting the subjects to those with cerebrovascular disease is that previous studies which showed beneficial effects of ACEI on dysphagia were mostly based on stroke patients.

Exclusion criteria

• life expectancy less than six months;
• live outside Shatin area;
• systolic blood pressure less than 100 mm Hg;
• known intolerance of ACEI;
• existing use of ACEI or angiotensin receptor blockers;
• symptomatic chronic lung disease or cardiac failure;
• frequent withdrawal of enteral tube by patients;
• serum creatinine >100 µmol/L;
• serum potassium > 5.1 mmol/L.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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93 participants in 2 patient groups, including a placebo group

Angiotensin converting enzyme inhibitor

Experimental group

Description:

Angiotensin converting enzyme inhibitor (Lisinopril), 2.5mg, nocte, 26 weeks

Treatment:

Drug: Angiotensin converting enzyme inhibitor (Lisinopril)

Placebo

Placebo Comparator group

Description:

Placebo

Treatment:

Drug: Placebo