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Randomized Controlled Trial
. 2011 Jan 7:11:1.
doi: 10.1186/1471-2466-11-1.

Design of the exhale airway stents for emphysema (EASE) trial: an endoscopic procedure for reducing hyperinflation

Pallav L Shah  1 , Dirk-Jan Slebos, Paulo F G Cardoso, Edward J Cetti, Gerhard W Sybrecht, Joel D Cooper
Affiliations
Randomized Controlled Trial

Design of the exhale airway stents for emphysema (EASE) trial: an endoscopic procedure for reducing hyperinflation

Pallav L Shah et al. BMC Pulm Med. .

Abstract

Background: Airway Bypass is a catheter-based, bronchoscopic procedure in which new passageways are created that bypass the collapsed airways, enabling trapped air to exit the lungs. The Exhale Airway Stents for Emphysema (EASE) Trial was designed to investigate whether Exhale® Drug-Eluting Stents, placed in new passageways in the lungs, can improve pulmonary function and reduce breathlessness in severely hyperinflated, homogeneous emphysema patients (NCT00391612).

Methods/design: The multi-center, randomized, double-blind, sham-controlled trial design was posted on http://www.clinicaltrials.gov in October 2006. Because Bayesian statistics are used for the analysis, the proposed enrollment ranged from 225 up to 450 subjects at up to 45 institutions. Inclusion criteria are: high resolution CT scan with evidence of homogeneous emphysema, post-bronchodilator pulmonary function tests showing: a ratio of FEV1/FVC < 70%, FEV1 ≤ 50% of predicted or FEV1 < 1 liter, RV/TLC ≥ 0.65 at screening, marked dyspnea score ≥ 2 on the modified Medical Research Council scale of 0-4, a smoking history of at least 20 pack years and stopped smoking for at least 8 weeks prior to enrollment. Following 16 to 20 supervised pulmonary rehabilitation sessions, subjects were randomized 2:1 to receive either a treatment (Exhale® Drug-Eluting Stent) or a sham bronchoscopy. A responder analysis will evaluate the co-primary endpoints of an FVC improvement ≥ 12% of the patient baseline value and modified Medical Research Council dyspnea scale improvement (reduction) ≥ 1 point at the 6-month follow-up visit.

Discussion: If through the EASE Trial, Airway Bypass is shown to improve pulmonary function and reduce dyspnea while demonstrating an acceptable safety profile, then homogeneous patients will have a minimally invasive treatment option with meaningful clinical benefit.

Trial registration: ClinicalTrials.gov: NCT00391612.

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Figures

Figure 1
Figure 1
Exhale Doppler probe tip.
Figure 2
Figure 2
Exhale Transbronchial Dilation Needle (extended tip), with the dilation balloon inflated.
Figure 3
Figure 3
Exhale Drug-Eluting Stent (white), and underlying balloon mounted on the delivery catheter. The rounded tip at the end of the catheter makes it easier to place the stent catheter in the passage.
Figure 4
Figure 4
Exhale Drug-Eluting Stents.
Figure 5
Figure 5
Airway Bypass procedure steps.
Figure 6
Figure 6
CONSORT flowchart.
See this image and copyright information in PMC

References

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