COPD
Conditions
Keywords
COPD, sleep, daytime somnolence
Brief summary
Fluticasone (Advair), an inhaled corticosteroid and salmeterol, a long-acting beta agonist, are approved for use in the management of COPD. Fluticasone/salmeterol has been shown to significantly improve forced expiratory volume (FEV1) and decrease COPD symptoms (Calverley et al. 2003, 2007). Inhaled corticosteroids have been shown to decrease frequency of COPD exacerbations (Gartlehner et al. 2006) and long acting bronchodilators demonstrated a reduction in dyspnea, increased airflow and reduction in hyperinflation in patients with symptomatic COPD (Ramirez-Venegas et al. 1997). Specifically, salmeterol has also been shown to have a positive effect on symptoms and health status of patients with COPD when added to usual treatment (Stockley et al. 2006). Previous research of subjects from our group with asthma has shown salmeterol to be associated with sustained improvements in morning peak expiratory flow (PEF), protection from nighttime lung function deterioration and improvement in patient perception of sleep (Wiegand et al. 1999). This study has not been performed in patients with COPD nor has the effect of salmeterol with fluticasone on sleep quality been assessed. AIM: The aim of this study is to determine the effect of fluticasone/salmeterol on sleep quality in patients with COPD and to compare efficacy of Advair 250 compared to placebo on sleep. The hypothesis is that there would be a significant improvement in sleep quality when patients are placed on fluticasone/salmeterol as compared to placebo.
Detailed description
RATIONALE: Chronic obstructive pulmonary disease (COPD) is a term that describes a disease state in which there is chronic irreversible airflow limitation. It has been well documented that patients with COPD have disturbed sleep. Certain published reports suggest that more than 50% of COPD patients have sleep complaints (George et al., Drugs, 2003). These patients are found to have sleep onset latency and poor sleep maintenance. While their sleep disturbance may be explained in part by side effects of medications, it could also be a result of nocturnal gas exchange abnormalities (Knutty 2004). In COPD there is worsening hypoxemia and hypercapnia during sleep, particularly rapid eye movement (REM) sleep, and sleep disturbance seems to be worse with more severe COPD. It is commonly believed that optimizing medical management of the disease is important in improving the sleep quality of these patients and thus leading to improved quality of life. Fluticasone, an inhaled corticosteroid and salmeterol, a long-acting beta agonist, are approved for use in the management of COPD. Fluticasone/salmeterol has been shown to significantly improve FEV1 and decrease COPD symptoms (Calverley et al. 2003, 2007). Inhaled corticosteroids have been shown to decrease frequency of COPD exacerbations (Gartlehner et al. 2006) and long acting bronchodilators demonstrated a reduction in dyspnea, increased airflow and reduction in hyperinflation in patients with symptomatic COPD (Ramirez-Venegas et al. 1997). Specifically, salmeterol has also been shown to have a positive effect on symptoms and health status of patients with COPD when added to usual treatment (Stockley et al. 2006). Previous research of subjects from our group with asthma has shown salmeterol to be associated with sustained improvements in morning PEF, protection from nighttime lung function deterioration and improvement in patient perception of sleep (Wiegand et al. 1999). This study has not been performed in patients with COPD nor has the effect of salmeterol with fluticasone on sleep quality been assessed. AIM: The aim of this study is to determine the effect of fluticasone/salmeterol on sleep quality in patients with COPD and to compare efficacy of Advair 250 compared to placebo on sleep. The hypothesis is that there would be a significant improvement in sleep quality when patients are placed on fluticasone/salmeterol as compared to placebo.
Interventions
DRUGAdvair 250
1 puff bid inhaled
DRUGPlacebo- matched
1 puff bid inhaled
DRUGPlacebo
Placebo 1 puff bid inhaled
DRUGAdvair 250 - matched
i puff bid inhaled
Sponsors
GlaxoSmithKline
Milton S. Hershey Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
45 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Patients with moderate to severe COPD as per GOLD criteria 2. Insomnia, poor sleep, non-restorative sleep or daytime sleepiness by history 3. Age 45 to 75 years, male or female 4. FEV1 below 80% of predicted using CRAPO 5. FEV1/FVC \< 70% predicted 6. Past or present tobacco smoker 7. Female patients must be postmenopausal for 1 year or be willing to use birth control or abstain from sex.
Exclusion criteria
1. Asthma 2. Use of oral or injectable corticosteroids within 2 months 3. Previous diagnosis of sleep disorder breathing (sleep apnea, narcolepsy, etc.) 4. Lung or heart disease except for COPD 5. Deviated nasal septum, nasal polyps or anatomic obstruction of the nose 6. Obesity defined as BMI \>30kg/m2 7. Inability to tolerate or history of allergy to long acting beta agonist or inhaled corticosteroid therapy. 8. Inability to complete a 2 week run-in with albuterol prn as only therapy 9. Use of narcotics, sleep aids, sedating antihistamines, sedatives, MAO Inhibitors, and other medications known to affect daytime somnolence or sleep quality 10. Excessive use of alcohol or use of recreational drugs 11. Use of narcotics, sleep aids, sedatives or sedating antihistamines. 12. Night shift workers 13. Women who are breast feeding or pregnant.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The Aim of This Study is to Determine the Effect of Fluticasone/Salmeterol on Sleep Quality in Patients With COPD and to Compare Efficacy of Advair 250 Compared to Placebo on Sleep. | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Daytime Somnolence | 1 year |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo, Then Advair 250- Matched 1 puff bid Placebo for two weeks followed by a 4 week washout period with placebo. After the washout period, they then received Advair 250- matched 1 puff bid for two weeks | 0 |
| Advair 250, Then Placebo- Matched 1 puff bid Advair 250 for two weeks followed by a 4 week washout period with placebo. After the washout period, they then received Placebo- matched 1 puff bid for two weeks | 0 |
| Total | 0 |
Baseline characteristics
| Characteristic | — |
|---|---|
| Region of Enrollment United States | — participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 10 |
| other Total, other adverse events | 0 / 10 | 0 / 10 |
| serious Total, serious adverse events | 0 / 10 | 0 / 10 |
Outcome results
Primary
The Aim of This Study is to Determine the Effect of Fluticasone/Salmeterol on Sleep Quality in Patients With COPD and to Compare Efficacy of Advair 250 Compared to Placebo on Sleep.
Time frame: 1 year
Population: Th PI has left the Institution and no outcome data are available for reporting. Sincere efforts were made to obtain the data, but were unsuccessful.
Secondary
Daytime Somnolence
Time frame: 1 year
Population: Th PI has left the Institution and no outcome data are available for reporting. Sincere efforts were made to obtain the data, but were unsuccessful.