The purpose of this study is to evaluate the effectiveness of treatment with triple therapy an inhaler that contains three types of asthma medications, on participants with poorly controlled asthma. The triple therapy medication contains fluticasone furoate, an inhaled corticosteroid (ICS) which reduces inflammation in the lungs; umeclidinium (UMEC), a long-acting muscarinic antagonist (LAMA), a medication which helps open up the airways; and vilanterol (VI), a long-acting beta2-adrenergic agonist (LABA) which also helps open up airways, delivered in a single daily inhalation via an Ellipta inhaler. The Investigators will evaluate lung structure and function using magnetic resonance imaging (MRI). Participants will inhale xenon gas before an MRI image of their lungs is taken. Using a special technique xenon is visible in MRI images, so this lets us see how air spreads in the lungs. In healthy lungs, the gas fills the lungs evenly, but in unhealthy lungs, the gas may fill the lungs unevenly and they will appear patchy. The patchy areas are called ventilation defects. A CT of the chest will be done to assess the structure of the lungs. The Investigators will also be using lung function testing and questionnaires to compare them to MRI ventilation defect measurements.
This is an open-label, single arm pilot study in participants prescribed low or medium dose ICS/LABA inhaled therapy and poorly controlled asthma to quantify hyperpolarized 129Xe MRI VDP before and after six weeks of therapy with FF/UMEC/VI 200/62.5/25 ug QD. Male and females between 18 and 70 years of age will provide written informed consent to five visits including screening (Visit 1 week -2), baseline (Visit 2 week 0), mid-study Visit 3 in week 3, study end (Visit 4, week +6) and safety follow-up (Visit 5 week +8). The general study procedures are the same for Visit 1/Day -14, Visit 2/Day 0 and Visit 4/Day 42. Visit 3/Day 21 is an optional clinic visit or phone call. Visit 5 is a phone call check-in for adverse events. For Visits 1, 2 and 4, participants are to withhold their medication as previously described. Vital signs will be recorded at the beginning of the visit. FeNO, spirometry, plethysmography, FOT, MBNW and 129Xe MRI will be performed pre-bronchodilator. FeNO will be performed before all other pulmonary function testing. Following 129Xe MRI, all participants will inhale 4 puffs (100mcg each) of a bronchodilator and quietly rest for 15 minutes. After 15 minutes, participants will undergo post-bronchodilator 129Xe MRI, and once MRI is complete, participants will undergo post-bronchodilator spirometry, plethysmography, FOT and MBNW. SGRQ, ACQ-6 and AQLQ will be administered after post-bronchodilator assessments are completed. For Visit 3, participants who choose to attend an in-person visit are to withhold their medication as described and the process for Visits 1, 2 and 4 will be followed. Participants who choose a phone call Visit 3 will be asked a series of questions regarding their breathing, asthma control and general health and they will complete the SGRQ, ACQ and AQLQ. For all participants, Visit 5 will entail a phone call check-in for adverse events. CT will be acquired at Visit 2, whilst MRI will be acquired on Visits 2, 4 and for those who prefer an in person visit, on Visit 3.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
31
The investigational drug is a single Ellipta inhaler containing 200 ug fluticasone furoate, 62.5 ug umedlidinium and 25 ug vilanterol. The drug is delivered in an Ellipta inhaler in a single dose once daily.
Robarts Research Institute; The University of Western Ontario; London Health Sciences Centre
London, Ontario, Canada
Change From Baseline Airway Function Measured Using 129-Xenon MRI Ventilation Defect Percent at the End of 6 Weeks of Treatment With FF/UMEC/VI 200/62.5/25ug Once Daily
Change in VDP
Time frame: Day 0 to day 42
Change From Baseline Forced Expiration Volume in One Second
Indicator of pulmonary function
Time frame: Baseline and Day 42
Change From Baseline Forced Vital Capacity
Indicator of pulmonary function
Time frame: Baseline and Day 42
Change From Baseline Residual Volume
Indicator of pulmonary function
Time frame: Baseline and Day 42
Change From Baseline Total Lung Capacity
Indicator of pulmonary function
Time frame: Baseline and Day 42
Change From Baseline in Proximal Airway Reactance at 5 Hz (R5), 19 Hz (R19), and 5 Hz - 19 Hz (R5-19)
Indicator of pulmonary function and inflammation
Time frame: Baseline and Day 42
Change From Baseline Lung Clearance Index
Lung clearance index is the number of breaths it takes until the exhaled nitrogen concentration is \<2.5% of the concentration at the start of the test. It is an indicator of pulmonary function. A lower value is considered better as it indicates it takes a lower number of breaths for the nitrogen to exit the lungs.
Time frame: Baseline and Day 42
Change From Baseline in Asthma Control
Asthma Control Questionnaire (ACQ-6) is used to evaluate asthma control. The ACQ-6 is scored from 0 to 6, with higher scores indicating more severely uncontrolled asthma.
Time frame: Baseline and Day 42
Change From Baseline in Asthma-related Quality of Life
Asthma Quality of Life Questionnaire with Standardised Activities (AQLQ(S)) evaluates asthma-related quality of life. The AQLQ(S) is scored from 1-7, with lower scores indicating more severe impairment.
Time frame: Baseline and Day 42
Change From Baseline in Daily Life and Perceived Well-being Using the SGRQ.
The St. George's Respiratory Questionnaire (SGRQ) is a 2-part questionnaire with a score of 0-100, with higher numbers indicating more limitations.
Time frame: Baseline and Day 42
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