Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
Impact of Low-dose Computed Tomography on the Management of Chronic Obstructive Pulmonary Disease Patients: an Evidence-based Study
Verified date | November 2015 |
Source | Azienda Ospedaliero-Universitaria di Parma |
Contact | n/a |
Is FDA regulated | No |
Health authority | Italy: Ethics Committee |
Study type | Interventional |
Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of
chronic morbidity and mortality worldwide. There is debate about diagnosis and management of
COPD because it was described as complex syndrome accounting for various pulmonary and
extrapulmonary abnormalities. As a result, there is consensus that both clinical evaluation
and pulmonary function tests (PFTs) data by themselves do not adequately describe the
complexity of the disease. The chest radiograph is the sole imaging examination recommended
for the routine evaluation of these patients by the physicians guidelines (GOLD
guidelines),which, however, are also debating on the utility of computed tomography (CT) in
this setting. Indeed, a number of studies reported a dramatic increasing use of CT of the
chest for COPD assessment, in both clinical and research settings. COPD assessment by CT
seems to improve the accuracy and completeness of the clinical evaluation of these patients.
Nevertheless, the clinical utility of CT has yet to be proved by prospective studies or
defined by guidelines.
Objectives: To evaluate the change in the diagnosis and management of COPD when multiple
CT-derived information is added to pre-test evaluation.
Methods: Four pulmonologists with various expertise in the field will review clinical data,
PFTs results, and chest radiographs of 200 consecutive COPD patients diagnosed according to
current guidelines. Therefore, after two months from the first evaluation, the
pulmonologists will review the clinical and PFTs records with comprehensive information
about low-dose CT (LDCT) previously performed in a week from the chest radiograph.
Information about LDCT findings will include qualitative assessment by an experienced chest
radiologist and quantitative analysis by means of an innovative 3D imaging dedicated
software. Phenotype assessment and patient care decisions (e.g. therapeutic and follow-up
strategies, need of additional tests etc.) will be recorded before and after assimilation of
LDCT data.
Expected results: This evidence-based prospective study will test the impact of chest LDCT
on management of COPD patient. In addition, the level of agreement between pulmonologists in
terms of diagnosis and therapeutic strategies will be assessed. Furthermore, the study will
evaluate the need for additional tests referable to LDCT information and their impact on the
health care system (e.g. in terms of additional costs).
Status | Completed |
Enrollment | 195 |
Est. completion date | September 2015 |
Est. primary completion date | September 2015 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 40 Years to 90 Years |
Eligibility |
Inclusion Criteria: - COPD diagnosis according to ATS/ERS criteria (post-bronchodilator FEV1 to FVC ratio < 0.7); - clinical stability, namely no acute exacerbation in the previous 4 weeks; - clinical indication for low-dose computed tomography (LDCT) to investigate bronchiectasis, interstitial lung disease, or pulmonary hypertension. Exclusion Criteria: - pregnancy; - patients with congenital or acquired immune deficit; - patients with lung transplantation; - patients under oxygen therapy; - patients with diagnosis of asthma or other clinically relevant pulmonary disease other than COPD. |
Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
Azienda Ospedaliero-Universitaria di Parma |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Impact of diagnostic imaging in assessing COPD by qualitative and quantitative evaluation (questionnaire) | To quantify the refinement of the diagnosis of COPD patients when LDCT data are added to standard evaluation, namely, conventional clinical-functional assessment and chest radiography. | Up to 3 years | No |
Primary | Clinical management of COPD in relation to therapy adjustment (questionnaire) | To describe the change in management of COPD patients when LDCT data are added to standard evaluation, namely, conventional clinical-functional assessment and chest radiography. | Up to 3 years | No |
Secondary | Intra-observer agreement before and after disclosure of LDCT features (questionnaire) | To assess the intra-observer agreement of pulmonologists before and after assimilation of LDCT data. | Up to 3 years | No |
Secondary | Inter-observer agreement (questionnaire) | To assess changes in inter-observer agreement between pulmonologist before and after assimilation of LDCT data. | Up to 3 years | No |
Secondary | Additional costs derived from change in management of COPD after disclosure of LDCT features (comparison of costs) | To evaluate additional costs for the regional health care system deemed by assimilation of LDCT data. | Up to 3 years | No |
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