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Mediator Release During Exercise-induced Bronchoconstriction

Primary Purpose

Exercise Induced Asthma

Status
Unknown status
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Exercise induced bronchoconstriction
Inhibited EIB
Sponsored by
Brunel University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Exercise Induced Asthma

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Able to understand the study instructions
  • Willing and able to give informed consent
  • Aged 18-50yr
  • Physician-diagnosed asthma and/or EIB
  • Participants that demonstrate EIB at the screening visit (i.e., those who have a fall in FEV1 20% to 50%) will be eligible for the full study.

Exclusion Criteria:

  • Any chronic medical condition other than asthma or EIB
  • Baseline FEV1 <70% predicted
  • Exacerbation of asthma or respiratory infection within the last 4 wk
  • Individuals who have varied their inhaled corticosteroid medication within the last 4 wk
  • History of anaphylaxis
  • Current smokers
  • Pregnancy
  • History of cardiovascular disease
  • Injury that would prevent exercise on a cycle ergometer
  • Medical contraindication to perform strenuous exercise
  • Required oral corticosteroids in the past 3 months
  • Any blood borne disease

Sites / Locations

  • Brunel University LondonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

No Intervention

Arm Label

Exercise induced bronchoconstriction

Inhibited EIB

Control

Arm Description

An exercise challenge will then be performed according to international guidelines. The exercise will consist of 8 minutes of cycling on a cycle ergometer while breathing medical grade dry air from a reservoir (Douglas bag) via a two-way non-rebreathing valve. The workload will be increased progressively over the first 2 minutes, and will then be maintained for 6 minutes at a target workload (in Watts) of [53.76 * measured forced expiratory volume in 1 sec (FEV1)-11.07].

An exercise challenge will then be performed according to international guidelines. The exercise will consist of 8 minutes of cycling on a cycle ergometer while warm-humid air from a reservoir (Douglas bag) via a two-way non-rebreathing valve. The workload will be increased progressively over the first 2 minutes, and will then be maintained for 6 minutes at a target workload (in Watts) of [53.76 * measured forced expiratory volume in 1 sec (FEV1)-11.07].

Participants will attend the laboratory but no exercise trial will be performed.

Outcomes

Primary Outcome Measures

Changes in the concentration of inflammatory mediator metabolites in urine
Concentration of metabolites of prostaglandin-D2, Cysteinyl-Leukotrienes, prostaglandin-E2, prostacyclin, thromboxane and isoprostanes will be expressed as pg per mmol of creatinine.

Secondary Outcome Measures

Changes in the concentration of inflammatory mediator metabolites in blood plasma
Concentration of tryptase and pro-inflammatory cytokines measured from blood plasma samples.
Forced vital capacity (FVC) manoeuvres using spirometry
Forced expiratory volume in one second (FEV1) measured in litres will be used to determine the severity of EIB from baseline to post-exercise challenge.
Breathing rate
Breathing rate (breaths per minute) will be recorded throughout exercise to control intensity between trials.
Heart rate
Heart rate (beats per minute) will be recorded throughout the exercise challenge test to control intensity between trials.
Rating of breathing discomfort
Modified Borg scale (0- no discomfort, 10- severe discomfort).
Description of breathing discomfort
Descriptors from patients to describe the level of discomfort - i.e. 'my chest is tight'.

Full Information

First Posted
April 20, 2018
Last Updated
January 28, 2019
Sponsor
Brunel University
Collaborators
Karolinska Institutet
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1. Study Identification

Unique Protocol Identification Number
NCT03524053
Brief Title
Mediator Release During Exercise-induced Bronchoconstriction
Official Title
Mediator Release During Exercise-induced Bronchoconstriction
Study Type
Interventional

2. Study Status

Record Verification Date
January 2019
Overall Recruitment Status
Unknown status
Study Start Date
November 1, 2018 (Actual)
Primary Completion Date
March 2020 (Anticipated)
Study Completion Date
March 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brunel University
Collaborators
Karolinska Institutet

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This study will compare the inflammatory response in induced vs inhibited exercise induced bronchoconstriction (EIB) in patients with a medical diagnosis of asthma/EIB. Urinary and plasma samples will be analysed to compare the mediator release in each condition, alongside changes in lung function.
Detailed Description
Exercise induced-bronchoconstriction (EIB) is a transient narrowing of the airways that occurs during or shortly after strenuous exercise. The prevalence of EIB in asthmatic patients is estimated around 30-50%, but EIB can also occur in individuals without asthma (especially children, army recruit forces, and elite athletes). Controversy remains about the causative mediators in the bronchoconstrictive response. Technological advancement in mass spectrometry has opened new avenues in the quantitative measurement of small endogenous metabolites in biological fluids (including urine and blood), which may provide insights into the pathophysiology of EIB and direct future therapeutic targets. Utilising novel techniques in the analysis of inflammatory mediators in urine and blood, this study aims to conduct the most comprehensive analysis of mediator release during EIB to date. Participants will attend a screening visit during which they will complete an exercise challenge (to determine the presence of EIB). A skin prick test will also be conducted to establish the atopic status of the participants. Following the screening visit, patients with EIB will be invited to complete a randomised cross-over study, where they will perform two further exercise challenges on separate days: one while inhaling temperate dry air, and one while inhaling hot humid air (the latter is known to inhibit EIB). Lung function and breathing discomfort will be recorded, and urine and blood samples will be collected, before and at various time points after exercise. As a control condition, participants will also attend one visit during which no exercise will be performed. Participants aged 18-50yr, with diagnosed asthma and/or EIB, will be included in the study. 12 participants will complete 4 visits (lasting between 90 min and 4.5h). The study will take place on Brunel University London campus, Uxbridge. Urine and blood samples will be sent to the Karolinska Institutet, Stockholm, Sweden for analysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Exercise Induced Asthma

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Patients will undertake 3 separate conditions in a randomised order.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Exercise induced bronchoconstriction
Arm Type
Experimental
Arm Description
An exercise challenge will then be performed according to international guidelines. The exercise will consist of 8 minutes of cycling on a cycle ergometer while breathing medical grade dry air from a reservoir (Douglas bag) via a two-way non-rebreathing valve. The workload will be increased progressively over the first 2 minutes, and will then be maintained for 6 minutes at a target workload (in Watts) of [53.76 * measured forced expiratory volume in 1 sec (FEV1)-11.07].
Arm Title
Inhibited EIB
Arm Type
Active Comparator
Arm Description
An exercise challenge will then be performed according to international guidelines. The exercise will consist of 8 minutes of cycling on a cycle ergometer while warm-humid air from a reservoir (Douglas bag) via a two-way non-rebreathing valve. The workload will be increased progressively over the first 2 minutes, and will then be maintained for 6 minutes at a target workload (in Watts) of [53.76 * measured forced expiratory volume in 1 sec (FEV1)-11.07].
Arm Title
Control
Arm Type
No Intervention
Arm Description
Participants will attend the laboratory but no exercise trial will be performed.
Intervention Type
Other
Intervention Name(s)
Exercise induced bronchoconstriction
Other Intervention Name(s)
Induced bronchoconstriction
Intervention Description
Participants will exercise whilst inhaling dry-air, this is known to exacerbate the bronchoconstrictive response.
Intervention Type
Other
Intervention Name(s)
Inhibited EIB
Other Intervention Name(s)
Exercise-control
Intervention Description
Participants will perform the exercise-test whilst inhaling warm-humid air. This is known to inhibit the EIB response and will provide a direct comparison group for the EIB condition.
Primary Outcome Measure Information:
Title
Changes in the concentration of inflammatory mediator metabolites in urine
Description
Concentration of metabolites of prostaglandin-D2, Cysteinyl-Leukotrienes, prostaglandin-E2, prostacyclin, thromboxane and isoprostanes will be expressed as pg per mmol of creatinine.
Time Frame
Urine sample will be collected 45 minutes and immediately prior to the exercise challenges (or controlled resting period) and at 45, 90, 135 and 180 minutes post-exercise.
Secondary Outcome Measure Information:
Title
Changes in the concentration of inflammatory mediator metabolites in blood plasma
Description
Concentration of tryptase and pro-inflammatory cytokines measured from blood plasma samples.
Time Frame
Urine sample will be collected 45 minutes and immediately prior to the exercise challenges (or controlled resting period) and at 45, 90, 135 and 180 minutes post-exercise.
Title
Forced vital capacity (FVC) manoeuvres using spirometry
Description
Forced expiratory volume in one second (FEV1) measured in litres will be used to determine the severity of EIB from baseline to post-exercise challenge.
Time Frame
Spirometry will be performed 45 minutes and immediately prior to the exercise challenges (or controlled resting period) and at 45, 90, 135 and 180 minutes post-exercise.
Title
Breathing rate
Description
Breathing rate (breaths per minute) will be recorded throughout exercise to control intensity between trials.
Time Frame
Continuous recording throughout 8-min exercise test using the online breath-by-breath analysis system.
Title
Heart rate
Description
Heart rate (beats per minute) will be recorded throughout the exercise challenge test to control intensity between trials.
Time Frame
Continuous recording continuously throughout the 8-min exercise test using short-range radiotelemetry using a chest belt worn by the participant.
Title
Rating of breathing discomfort
Description
Modified Borg scale (0- no discomfort, 10- severe discomfort).
Time Frame
Breathing discomfort severity ratings will be recorded every 2 minutes throughout the 8 min exercise test (a total of 4 measurements)
Title
Description of breathing discomfort
Description
Descriptors from patients to describe the level of discomfort - i.e. 'my chest is tight'.
Time Frame
A description of breathing discomfort will be recorded every 2 minutes throughout the 8 min exercise test (a total of 4 measurements)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able to understand the study instructions Willing and able to give informed consent Aged 18-50yr Physician-diagnosed asthma and/or EIB Participants that demonstrate EIB at the screening visit (i.e., those who have a fall in FEV1 20% to 50%) will be eligible for the full study. Exclusion Criteria: Any chronic medical condition other than asthma or EIB Baseline FEV1 <70% predicted Exacerbation of asthma or respiratory infection within the last 4 wk Individuals who have varied their inhaled corticosteroid medication within the last 4 wk History of anaphylaxis Current smokers Pregnancy History of cardiovascular disease Injury that would prevent exercise on a cycle ergometer Medical contraindication to perform strenuous exercise Required oral corticosteroids in the past 3 months Any blood borne disease
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hannah Marshall, MSc
Phone
+447584168742
Email
hannah.marshall@brunel.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Pascale Kippelen, PhD
Phone
01895267649
Email
pascale.kippelen@brunel.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hannah Marshall, MSc
Organizational Affiliation
Brunel University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brunel University London
City
Uxbridge
State/Province
Middlesex
ZIP/Postal Code
UB8 3PH
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hannah Marshall, MSc
Phone
+447584168742
Email
hannah.marshall@brunel.ac.uk
First Name & Middle Initial & Last Name & Degree
Pascale Kippelen, PhD
Phone
01895267649
Email
pascale.kippelen@brunel.ac.uk

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Mediator Release During Exercise-induced Bronchoconstriction

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