Sputum Cytometry Guided Management for the Elimination of Chronic Cough in Patients With ILD

SpECC-ILD is an open-label, randomized controlled trial assessing the efficacy of sputum-guided management (using sputum cytometry) compared to standard care over 16 weeks in patients with chronic cough and ILD.

A total of 80 participants will be enrolled and randomized in a 1:1 ratio to either sputum guided therapy or standard of care for a total of 16 weeks. Participants randomized to the intervention arm will receive open-label sputum-guided management of airway inflammation identified during screening. Participants in this arm will receive standard of care treatment as determined by their ILD specialist who will be blinded to the results of the sputum analysis.

Inclusion criteria

• Written informed consent consistent with ICH-GCP and local laws, signed prior to any study procedures being performed
• Age >18 years
• A clinical diagnosis of ILD with accepted specific diagnoses including:
• Idiopathic pulmonary fibrosis (IPF)
• Chronic hypersensitivity pneumonitis associated ILD (CHP-ILD)
• Connective tissue disease associated ILD (CTD-ILD)
• Pneumoconiosis
• Daily Cough for at least 8 weeks
• Able to produce an adequate sample with sputum induction

Exclusion criteria

• Patients with a diagnosis of systemic sclerosis associated ILD (SSc-ILD) or sarcoidosis
• Cause of cough attributed to a known etiology (ex. ACE-inhibitor, uncontrolled gastroesophageal reflux or upper airway cough syndrome, acute viral illness)
• Current use of inhaled corticosteroids
• Current use of systemic corticosteroids (prednisone equivalent > 20mg/day)
• Current use of chronic antibiotics
• Airflow obstruction (ie. pre-bronchodilator FEV1/FVC ratio < 0.7)
• History of physician-diagnosed asthma
• History of emphysema
• A history of cholestatic jaundice or hepatic dysfunction associated with prior use of azithromycin
• Moderate to severe hepatic dysfunction with a Child Pugh score >10
• Known allergy or hypersensitivity to inhaled corticosteroids or macrolide antibiotics
• Corrected QT-interval (QTc) on screening electrocardiogram (ECG) of > 450ms
• An established history of untreated atypical mycobacterial infection
• A history of hearing impairment, tinnitus, or vertigo
• Medication use likely to suppress cough (ex: morphine, gabapentin, amitriptyline)