CARES: Cardiorespiratory Diagnostic Study

Sponsor

Cambridge Respiratory Innovations Limited (Industry)

Overall Status

Enrolling by invitation

CT.gov ID

NCT04939558

Collaborator

Innovate UK (Other), National Institute for Health Research, United Kingdom (Other)

740

Enrollment

Location

17.9

Anticipated Duration (Months)

41.3

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study uses a new breathing device called 'N-Tidal C' handset which measures breathing patterns. Investigators have found that people with cardiac and respiratory illnesses breathe out a gas, called carbon dioxide (CO2), in a different way to healthy people. The pattern of breathed out CO2 (the waveform) varies according to the underlying health of the user's lungs. Monitoring these changes may help doctors to more accurately diagnose and monitor the most common and serious respiratory conditions.

Condition or Disease	Intervention/Treatment	Phase
COPD Asthma Lung Cancer Anemia Congestive Cardiac Failure Bronchiectasis Interstitial Lung Disease Long COVID Upper Respiratory Disease Healthy	Device: N-Tidal C handset

Detailed Description

Chronic Obstructive Pulmonary Disease (COPD) is among the most prevalent respiratory conditions, and in the top five causes of death worldwide. However, mis-diagnosis rates are high (both under- and over- diagnosis), owing to the lack of a simple, reliable and specific diagnostic test. In addition, COPD is often diagnosed late in the natural history of the disease, which misses the opportunity for early intervention, with early treatment and health-behaviour changes (smoking cessation).

Spirometry, the current gold standard for diagnosis, is unreliable (technique-dependent), crude (measures airflow), and non-specific (multiple respiratory conditions can produce similar patterns on spirometry). It also relies on proper administration by specially trained members of staff. As a result, spirometry is often (a) not performed before a speculative diagnosis of COPD is made, and (b) performed poorly, resulting in poor-quality information on which to base a respiratory diagnosis.

There is therefore a need for a simple, reliable, robust and accurate test for diagnosing COPD which is non-operator dependent, and non-technique dependent.

Currently, capnography is invasive, expensive and can only be recorded in specialist centres via a nasal cannula and micro-stream sampling of expired carbon dioxide in the intensive care setting. The N-Tidal C (NTC) handset, a new (CE-marked), hand-held, wireless device has been developed to monitor the user's Tidal Breathing CO2 (TBCO2) waveforms at rest, during normal tidal breathing. This device can be safely operated in the home environment, has a battery life of weeks, and has an isolated, disposable, breath pathway that isolates an individual's breath from the rest of the device, making it safe to reuse between patients after the outer casing has been decontaminated using a 3-stage disinfection process.

The N-Tidal technology has the potential to offer new insights into lung physiology (above and beyond those currently available from spirometry and lung function testing), and early evidence from CRI's previous clinical studies suggests that the TBCO2 data could be used to fingerprint and diagnose COPD.

Study Design

Study Type:

Observational [Patient Registry]

Anticipated Enrollment :

740 participants

Observational Model:

Cohort

Time Perspective:

Prospective

Official Title:

A Longitudinal Observational Study to Investigate the Patterns of Change in the Tidal Breathing CO2 Waveform, Measured Using the N-Tidal C Handset, in Patients With COPD Compared to Patients With Other Common Cardiorespiratory Conditions

Actual Study Start Date :

Jun 2, 2021

Anticipated Primary Completion Date :

Oct 30, 2022

Anticipated Study Completion Date :

Nov 30, 2022

Arms and Interventions

Arm	Intervention/Treatment
Chronic Obstructive Pulmonary Disease 245 participants - GOLD 1, 2, 3 / A, B, C	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Asthma 55 participants - Mild to moderate, not labelled as severe.	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Congestive cardiac failure 55 participants	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Anaemia 55 participants - with at least 50% of participants recruited having no history of chronic cardiorespiratory conditions	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Bronchiectasis 55 participants - Acquired or genetic, e.g. cystic fibrosis or other primary ciliary dyskinesias	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Lung cancer 55 participants - including rare types e.g. mesothelioma	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Interstitial Lung Disease 55 participants - including pulmonary fibrosis pneumoconiosis, asbestosis, sarcoidosis, amyloidosis	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Long COVID 55 participants	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Upper airway obstruction disorder 55 participants	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.
Healthy 55 participants - with no previous or current chronic cardiorespiratory diagnoses	Device: N-Tidal C handset Participants are to use the 'N-Tidal C' handset every day for 14 days. This will ideally be two times a day (once in the morning and once in the evening, before using any regular inhalers). Each breath record requires the participant to breathe through the mouthpiece for 75 seconds in a relaxed manner.

Outcome Measures

Primary Outcome Measures

Breath records from participants with Chronic Obstructive Pulmonary Disease (COPD) [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 245 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 6860 records

Secondary Outcome Measures

Breath records from Healthy volunteers (no previous or current cardiorespiratory diagnoses) [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Asthma [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Congestive cardiac failure [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Anaemia [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Bronchiectasis [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Lung cancer [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Interstitial Lung Disease [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Long COVID [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records
Breath records from participants with Upper airway obstruction disorder [12 months from First Patient First Visit (FPFV)]
Tidal Breathing CO2 waveform data from 55 participants collected using the N-Tidal C Handset. Each participant delivering 2 x breath records per day for 14 days = 1540 records

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Age > 18 years
Healthy volunteer (with no previous or current chronic cardiorespiratory diagnoses)

One of the following cardiorespiratory diagnoses:

COPD (GOLD 1, 2, 3 / A, B, C)*
Asthma (mild to moderate, not labelled as severe)*
Congestive cardiac failure*
Anaemia (with at least 50% of participants recruited having no history of chronic cardiorespiratory conditions)*
Bronchiectasis (acquired or genetic, e.g. cystic fibrosis or other primary ciliary dyskinesias)*
Lung cancer (including rare types e.g. mesothelioma)*
Interstitial Lung Disease (including pulmonary fibrosis pneumoconiosis, asbestosis, sarcoidosis, amyloidosis)*
Long COVID*
Upper airway obstruction disorder*
[Active pulmonary hypertension]
[Extrinsic Allergic Alveolitis]
[Active pulmonary embolism]

Exclusion Criteria:

Participants who, in the opinion of the chief investigator, or their delegate, are unlikely to comply with the requirements of the study;
Diagnosis of neuromuscular disorders;
Concurrent diagnosis of cardiorespiratory conditions (other than those listed in the inclusion criteria above) that, in the opinion of the chief investigator, would impact the conduct of the study
Participants who are acutely unwell, e.g. active exacerbation, very short of breath e.g. severe COPD (GOLD 4 / D) or end-stage IPF.
Inability to give written informed consent