How can we optimise inhaled beta2 agonist dose as ‘reliever’ medicine for wheezy pre-school children? Study protocol for a randomised controlled trial

Mukhopadhyay, Somnath, Seddon, Paul, Earl, Gemma, Wileman, Emma, Symes, Liz, Olden, Cathy, Alberti, Corinne, Bremner, Stephen, Lansley, Alison, Palmer, Colin N A and Beydon, Nicole (2016) How can we optimise inhaled beta2 agonist dose as ‘reliever’ medicine for wheezy pre-school children? Study protocol for a randomised controlled trial. Trials, 17 (541). ISSN 1745-6215

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Abstract

Background: Asthma is a common problem in children and, if inadequately controlled, may seriously diminish their quality of life. Inhaled short-acting beta2 agonists such as salbutamol are usually prescribed as ‘reliever’ medication to help control day-to-day symptoms such as wheeze. As with many medications currently prescribed for younger children (defined as those aged 2 years 6 months to 6 years 11 months), there has been no pre-licensing age-specific pharmacological testing; consequently, the doses currently prescribed (200–1000 μg) may be ineffective or likely to induce unnecessary side effects. We plan to use the interrupter technique to measure airway resistance in this age group, allowing us for the first time to correlate inhaled salbutamol dose with changes in clinical response. We will measure urinary salbutamol levels 30 min after dosing as an estimate of salbutamol doses in the lungs, and also look for genetic polymorphisms linked to poor responses to inhaled salbutamol.

Methods: This is a phase IV, randomised, controlled, observer-blinded, single-centre trial with four parallel groups (based on a sparse sampling approach) and a primary endpoint of the immediate bronchodilator response to salbutamol so that we can determine the most appropriate dose for an individual younger child. Simple randomisation will be used with a 1:1:1:1 allocation.

Discussion: The proposed research will exploit simple, non-invasive and inexpensive tests that can mostly be performed in an outpatient setting in order to help develop the evidence for the correct dose of salbutamol in younger children with recurrent wheeze who have been prescribed salbutamol by their doctor.

Trial registration: EudraCT2014-001978-33, ISRCTN15513131. Registered on 8 April 2015.

Item Type: Article
Keywords: Asthma; Wheeze; Children; Paediatric; Salbutamol; Dose finding
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RJ Pediatrics
Depositing User: Katie Isaac
Date Deposited: 07 Oct 2016 11:32
Last Modified: 16 Aug 2017 20:29
URI: http://sro.sussex.ac.uk/id/eprint/64031

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