Dyspnea Clinical Trial
Official title:
Nitric Oxide Gas Inhalation Therapy in Spontaneous Breathing Patients With Mild/Moderate COVID19 Infection: a Randomized Clinical Trial
The scientific community is in search for novel therapies that can help to face the ongoing epidemics of novel Coronavirus (COVID-19) originated in China in December 2019. At present, there are no proven interventions to prevent progression of the disease. Some preliminary data on SARS pneumonia suggest that inhaled Nitric Oxide (NO) could have beneficial effects on COVID-19 due to the genomic similarities between this two coronaviruses. In this study we will test whether inhaled NO therapy prevents progression in patients with mild to moderate COVID-19 disease.
To date, no targeted therapeutic treatments for the ongoing COVID-19 outbreak have been
identified. Antiviral combined with adjuvant therapies are currently under investigation. The
clinical spectrum of the infection is wide, ranging from mild signs of upper respiratory
tract infection to severe pneumonia and death.
In the patients who progress, the time period from symptoms onset to development of dyspnea
is reported to be between 5 to 10 days, and that one to severe respiratory distress syndrome
from 10 to 14 days. Globally, 15 to 18% of patients deteriorates to the need of mechanical
ventilation, despite the use of non-invasive ventilatory support in the earliest phases of
the disease. Probability of progress to end stage disease is unpredictable, with the majority
of these patients dying from multi-organ failure. Preventing progression in spontaneously
breathing patients with mild to moderate disease would translate in improved morbility and
mortality and in a lower use of limited healthcare resources.
In 2004, during the SARS-coronavirus (SARS-CoV) outbreak, a pilot study showed that low dose
( max 30 ppm) inhaled NO for 3 days was able to shorten the time of ventilatory support. At
the same time, NO donor compound S-nitroso-N-acetylpenicillamine increased survival rate in
an in-vitro model of SARS-CoV infected eukaryotic cells.Based on the genetic similarities
between the two viruses, similar effects of NO on COVID-19 can be hypothesized. While further
in-vitro testing is recommended, we proposed a randomized clinical trial to test the
effectiveness of inhaled NO in preventing the progression of COVID-19 related disease, when
administered at an early stage.
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