Asthma, Bronchiectasis, Chronic Lung Infections, Chronic Obstructive Pulmonary Disease, Copd, Lung Diseases, Obstructive
Conditions
Brief summary
The aim of this study is to determine whether an intervention with frequent thermotherapy will be able to reduce the amount of colonizing bacteria in the bronchoalveolar lavage sample and eradicate the colonizing bacteria.
Detailed description
Normally, bacterial lung infections are acute such as community-acquired pneumonia and typically resolve after antibiotic therapy without leaving much lasting damage on the lungs. However, a great amount of persons with disrupted clearance of mucus and/or lung immune system get persistent lung infections, which can be life-long, usually do not resolve even with antibiotics, and can greatly increase morbidity and mortality. IThese persistent lung infections are thus characterized by stable periods with exacerbations inbetween, akin to chronic lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis. In addition, it has not been thoroughly investigated whether antibiotic regimens have an effect on disease control, as biofilm formation prevents antibiotics from killing the bacteria. This is a randomized, controlled, multi-center, superiority trial evaluating the effect of a thermotherapy intervention, consisting of min. 7 minutes stay in min. 85℃ environment at least 4 times a week for 6 months, in persons with persistent bacterial lung infection, defined as min. 2 positive cultures during the last 24 months for one of the following bacteria: Pseudomonas aeruginosa, Achromobacter xylosoxidans, Stenotrophomonas maltophilia, Klebsiella oxytoca, Klebsiella pneumoniae, Haemophilus influenzae or Staphylococcus aureus, incl. 1 positive culture after attempted eradication therapy. The aim of the study is to investigate whether thermotherapy may offer a valid proposal for treatment of chronic lung infections.
Interventions
OTHERThermotherapy/sauna bath
Thermotherapy/sauna bath
Sponsors
Chronic Obstructive Pulmonary Disease Trial Network, Denmark
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Competent and capable * FEV1\>1,0 L * Have had a positive culture from sputum or BAL min. 2 times in the last 24 months for bacteria of the species: Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Staphylococcus aureus, Haemophilus influenzae, Achromobacter xylosoxidans, Klebsiella oxytoca or Klebsiella pneumoniae. In addition, min. 1 positive culture after treatment with antibiotics * Willing to go to a sauna (min. temperature of 85℃ for at least 7 minutes) four times weekly for six months or avoid going to a sauna for six months
Exclusion criteria
* Allergy to lidocaine and/or midazolam * Contraindications to bronchoscopy * Previous severe laryngospasm (intubation requiring) * Pregnancy/breastfeeding * Severe linguistic problems or inability to give informed consent * Severe mental illness that is not controlled with medication. NB: Patients with controlled mental illness can be included and will be asked on an equal footing as others
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of days from baseline without antibiotic treatment against pulmonary infection | 6 months | This is a measure of infectious exacerbations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of hospitalizations for all causes or death within 6 months | 6 months | — |
| Changes in antibiotic usage | 6 months | — |
| Number of antibiotic treatment regimes within 6 months | 6 months | — |
| Eradication of the cultured bacteria at baseline, defined by a) absence of the trial inclusion bacteria or b) the participant cannot expectorate dure to dry airways. | 6 months | Absence of bacteria, which lead to inclusion, is measured by a min. of 3 consecutive expectorates with a min. of 24 hours in between. |
| Physical performance measured by distance walked over 6 minutes | 6 months | — |
| Changes in FEV1 after 6 months | 6 months | — |
| Clinically relevant changes in Chronic Obstructive Pulmonary Disease Assessment Test-score (range from 0-40, higher is worse) after 6 months | 6 months | — |
| Changes in status from Medical Research Council-dyspnea score (range from 0-5, higher is worse) from <3 to 3≥, after 6 months | 6 months | — |
Countries
Denmark
Contacts
CONTACTJosefin V Eklöf, MD
CONTACTJens-Ulrik S Jensen, Professor
Outcome results
None listed