Peak Inspiratory Flow and Dry Powder Inhaler Performance in COPD

Pulmonary Research Institute of Southeast Michigan

Status and phase

Completed

Phase 4

Conditions

COPD

Treatments

Drug: Trelegy Ellipta 100/62.5/25Mcg Inh 30D

Drug: Ventolin 90Mcg/Actuation Inhalation Aerosol

Study type

Interventional

Funder types

Other

Industry

Identifiers

NCT04606394

001

Details and patient eligibility

About

The purpose of the study is to determine whether PIF is clinically important when using the Ellipta DPI device. In addition, the study will validate the best/most clinically appropriate way to perform a PIF maneuver, to determine the testing capabilities of the preferred PIF maneuver and to relate this PIF measurement to meaningful clinical outcomes in COPD patients

Full description

Study Design and Methods Rationale

The expected FEV1 response to a bronchodilator is uncertain as multiple factors influence this measure, including severity of disease, day to day variability, varying reversibility in COPD patients, the delivery of the drug to a patient and the effectiveness of the medication delivered. Thus, the measurement of an acute bronchodilator response after delivering a long acting bronchodilator may not identify whether a medication has been effectively delivered to a patient.
However, if a long acting bronchodilator has not been effectively delivered to the lung, then subsequent delivery of a short acting bronchodilator should produce a significant additional bronchodilator response. On the other hand, if a long acting bronchodilator has been effectively delivered to the lung, then subsequent delivery of a short acting bronchodilator should not produce any further significant bronchodilation.
Based on this rationale, comparison of the acute bronchodilator response to a short acting bronchodilator after receiving a long acting should identify whether drug delivery is ineffective in a selected patient population, irrespective of baseline FEV1 and of any partial response to the long acting bronchodilator. Comparison of the short acting bronchodilator measurement between patient groups with differing PIF thresholds should identify whether PIF has an impact of drug delivery of a long acting bronchodilator via a DPI.
Open label design comparing the acute bronchodilator response after delivery of a long acting bronchodilator via Ellipta DPI in patients with normal, suboptimal and minimal PIF.

Enrollment

30 patients

Sex

All

Ages

40+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

smoking history >10 pack years
pre-bronchodilator FEV1 <60% predicted
post-bronchodilator FEV1/FVC <70%
female participants are eligible to participate if they are not pregnant, not breastfeeding, and at least one of the following conditions applies:
not a woman of childbearing potential OR
agree to follow the contraceptive guidance during the treatment period and until the safety follow-up contact after the last dose of study treatment
stratification requiring at least 1/3 of patients having a PIF of < 60L/min (AM pre-dose based on using the level 2 InCheck Dial resistance setting with a sharp maximal effort starting after exhaling fully)

Exclusion criteria

any subject with unstable disease, including
COPD exacerbation in the last 6 weeks
upper respiratory tract in in the last 4 weeks
COPD or upper respiratory tract infection during run-in (subjects may be re-screened x 1 when stable after an acute event)
pulmonary disease other than COPD
any lung resection
unstable cardiac conditions (at the discretion of the investigator)
other unstable medical conditions (at the discretion of the investigator)