Asthma: Phenotyping EXacerbations

University of Nottingham200 enrolled

Overview

The main outcomes of this study are to establish a cohort of well-phenotyped asthma patients with a recent history of an exacerbation. We aim to describe exacerbation profiles (phenotypes) of the cohort in terms of inflammatory/biomarker profile and bacterial/viral infection status and to compare these with exacerbation events in the sister APEX cohort.

This is a single centre, observational, longitudinal cohort study. The study will consist of one group of approximately 200 patients with clinician diagnosed asthma, who have had at least one exacerbation in the past year before informed consent. They will be identified from secondary care, primary care and the Nottingham Respiratory Research Database (NRRD). After the Baseline visit, each subject will be followed for the duration of their participation in the study. Participants will be asked to contact the research team if they perceive that their asthma symptoms are worsening to the extent that they would usually seek help from a healthcare professional. They will then be invited to attend the Assessment Visit and potential Exacerbation Visit. Participants who complete this visit will then continue in the study, as we are interested in comparing subsequent events in the same individuals, to establish exacerbation stability and consistency. All participants, whether they have attended an Assessment visit or not, will be invited to attend for an Annual visit. The research team will also contact participants at 3 monthly intervals, with their permission, to discuss the study and provide updates.

Study Type

OBSERVATIONAL

Enrollment

200

Conditions

Asthma

Interventions

spirometry, FOT, Induced sputum, bloods, nasal brushes, nasal lavage, skin prick, throat swabDIAGNOSTIC_TEST

At the point of baseline visit, exacerbation and annual visit, the above tests will be performed to allow comparison of a participants profile before and during an exacerbation

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

INCLUSION * Clinician diagnosed asthma. * Male or female aged ≥ 18 and ≤ 85 years of age. * One asthma exacerbation requiring additional treatment in the year prior to informed consent. This is defined as either: 3 or more consecutive day's treatment with oral corticosteroids; for participants not on maintenance steroids, OR at least a doubling of treatment with oral corticosteroids for 3 or more consecutive days, from a stable dose, for participants on maintenance therapy with oral corticosteroids. These can be patient-reported. * On British Thoracic Society (BTS) step 1-5 treatment * Current smokers can be included, provided there is good evidence of underlying asthma (for example, a life-long history of asthma, \> 12% FEV1 reversibility or sputum or blood eosinophilia). * Able (in the Investigator's opinion) and willing to comply, with all clinical investigation requirements. * Non-English speaking participants should be proficient in their understanding of the English language, in order to be able to fully participate in the study. EXCLUSION: * Exacerbation in the 4 weeks prior to the Baseline visit. The use of biologic therapy, including Omalizumab, Mepolizumab or Benralizumab, at any time during the 3 months. * prior to informed consent. Participants who commence biologic therapy during the course of the study will be withdrawn. * A history more in keeping with smoking-related Chronic Obstructive Pulmonary Disease (COPD) * Other clinically significant respiratory diseases. * Use of regular high dose maintenance systemic corticosteroids (for example, a dose of \> 10mgs of Prednisolone daily) * Any other clinically significant medical disease or uncontrolled concomitant disease, that is likely, in the opinion of the investigator, to impact on the ability to participate in the study or the study results. * Pregnant women, lactating women or women who are planning to become pregnant. * Participants with uncontrolled hypertension. Participation in a study involving an investigational medicinal product at any time during the 3 months prior to informed consent.

Locations (1)

Nottingham respriatory research unit

Nottingham, Nottinghamshire, United Kingdom

RECRUITING

Outcomes

Primary Outcomes

Proportion of study participants with an eosinophilic and non eosinophhilic phenotype

Percentage of study participants with an eosinophilic and non eosinophhilic phenotype

Time frame: 3 years into the study

Secondary Outcomes

The proportion of exacerbations associated with confrimed viral and bacterial infection

The prercentage of participabnts within the cohort with at least one exacerbation associated with confirmed viral and bacterial infection by the end of the study

Time frame: 3 years

Asthma control questionnaire

ACQ score at baseline and then at exacerbation and annual visits. 0 is total control and 6 is severly uncontrolled

Time frame: 3 years

Medication Adherence Rating Scale (MARS)

MARS at baseline and then at exacerbation and annual visits. 5 questions are propposed each with a score scale 1 to 5. A score of 1 having the best and 5 having the worst.

Time frame: 3 years

Measuring Lung function and inflamamtion

Measure Forced Oscialltion Technique (FOT) and Spirometry and Fractional Exhaled Nitric Oxide (FENO) at baseline and then at exacerbation and anuual visits.

Time frame: 3 years

Blood profile

Measure FBC CRP IgE at baseline. During an exacerbation and annual visit, FBC CRP will be measured. Additional blood will be taken at each visit for future research

Time frame: 3 years

Nasal lavage fluid and throat swab

Nasal lavage will be preformed along side a throat swab to identify any virsuses at baseline, exacerbation and annual visits.

Central Contacts

Tim Professor Harrison, MBBS, BSc, FRCP, MD, MSc

CONTACT

0115 823 1714 tim.harrison@nottingham.ac.uk

Data from ClinicalTrials.gov

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