Inpatient Clinical Trial of NAC

Asthma Clinical Trial

— ICON  

Official title:

Inpatient Clinical Trial of NAC

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT03581084
• Other study ID #: 17-24231
• Secondary ID: P01HL128191
• Status: Terminated
• Phase: Phase 4
• Start date: July 6, 2018
• Est. completion date: October 6, 2018

Study information

• Verified date: September 2021
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to determine the beneficial effect of n-acetylcysteine (NAC), an inhaled medication that breaks down mucus, on lung function. NAC is a medication approved by the US Food and Drug Administration (FDA) for the treatment of chronic diseases of the respiratory system, including asthma. With CT lung imaging, the investigators seek to identify a subgroup of patients with asthma with a 'mucus' profile. This is a single-arm study which means all participants will receive the same treatment.

Description:

N-acetylcystine (NAC) is a mucolytic medication, meaning that it breaks apart mucus. Investigators know that mucus is a factor in severe asthma attacks. However, mucus may be a factor in chronic severe asthma as well. This role has been hard to prove because of difficulty in showing that mucus occludes the lumen in chronic severe disease. Using a novel approach of scoring mucus occlusion, investigators have used CT imaging to uncover that a majority of people with severe asthma have at least one lung segment with a mucus plug and 27% have more than four lung segments with mucus plugs.

Historically, studies of mucolytics, like NAC, have not shown benefit in other obstructive lung diseases, like COPD. However, utilizing CT mucus scores as a biomarker, investigators believe that mucolytic treatment may prove useful for those with significant mucus impaction.

This is a single-arm study of participants with asthma who also have evidence of mucus in their lungs as determined by CT imaging. Investigators hypothesize that by treating asthmatics, chosen based on the presence of mucus in the airways, with a mucolytic like NAC, will result in an improvement of lung function.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 1
• Est. completion date: October 6, 2018
• Est. primary completion date: July 13, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

1. Male or female between the ages of 18 and 80 years of age at Visit 1

2. Written informed consent obtained from subject and ability for subject to comply with the requirements of the study.

3. Able to perform reproducible spirometry according to ATS criteria

4. Physiological evidence of airflow obstruction (FEV1 bronchodilator reversibility of = 12% or hyperreactivity to methacholine reflected by a methacholine PC20 = 16 mg/mL)

5. Clinical history of asthma per patient report or medical record

6. Pre-bronchodilator FEV1 > 35% predicted

7. Post-bronchodilator FEV1 > 40% but < 90% predicted

8. Asthma requiring treatment with inhaled corticosteroids (ICS) for 3 months or greater

9. CT mucus score > 3

Exclusion Criteria:

1. Pregnant, breastfeeding, or unwilling to practice birth control during participation in the study.

2. Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data.

3. Smoking of tobacco or other recreational inhalants in last year and/or >10 pack-year smoking history

4. Current participation in an investigational drug trial

5. Other chronic pulmonary disorders, including (but not limited to) cystic fibrosis, chronic obstructive pulmonary disease, chronic bronchitis, vocal cord dysfunction (that is the sole cause of respiratory symptoms and at the PI's discretion), severe scoliosis or chest wall deformities that affect lung function, or congenital disorders of the lungs or airways

6. Unwillingness to follow study procedures

7. History of allergy or intolerance to study drug

8. Any other criteria that places the subject at unnecessary risk according to the judgment of the Principal Investigator

Related Conditions & MeSH terms

• Asthma

Intervention

Drug:
• N-acetylcysteine
Research participants that meet the study inclusion criteria will be admitted to a medical-surgical ward in Moffitt-Long Hospital (UCSF Medical Center) for 6 days and 5 nights and treated with an inhaled mixture of NAC and albuterol four times per day spaced at 4 to 6 hours apart.

Locations

Country	Name	City	State
United States	University of California, San Francisco	San Francisco	California

Sponsors (2)

Lead Sponsor	Collaborator
University of California, San Francisco	National Heart, Lung, and Blood Institute (NHLBI)

Country where clinical trial is conducted

United States, 

References & Publications (2)

DUNNILL MS. The pathology of asthma, with special reference to changes in the bronchial mucosa. J Clin Pathol. 1960 Jan;13:27-33. — View Citation

Hays SR, Fahy JV. The role of mucus in fatal asthma. Am J Med. 2003 Jul;115(1):68-9. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Forced Expiratory Volume in One Second (FEV1) Measurement	Post-treatment FEV1 is reported. FEV1 is measured via spirometry.	end of the one week treatment period
Secondary	Computed Tomography (CT) Scan Mucus Score	Post-treatment CT mucus scores will be compared to pre-treatment CT mucus score	From the start of the one week treatment period to the three month follow-up