ID

32950

Beschrijving

Study ID: 106827 Clinical Study ID: HZA106827 Study Title: HZA106827:A randomised, double-blind, placebo-controlled (with rescue medication), parallel group multicentre study of Fluticasone Furoate/GW642444 Inhalation Powder and Fluticasone Furoate Inhalation Powder alone in the treatment of persistent asthma in adults and adolescents Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT01165138 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: fluticasone furoate/vilanterol Trade Name: Allermist,Veramyst,Avamys; Relvar Study Indication: Asthma

Trefwoorden

  1. 18-11-18 18-11-18 -
  2. 21-11-18 21-11-18 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

21 november 2018

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0

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Fluticasone Furoate GW642444 Inhalation Powder and Fluticasone Furoate Inhalation Powder alone in the treatment of persistent asthma NCT01165138

Visit Assessments Complete (Visit 2) and Run-In-Failure, Randomisation Criteria, ICS/ LABA Concomitant Medications, Randomisation Number, Investigational Product, Vital Signs, Electronically Transferred Lab Data, Device Use Assessment, Subject Withdrawal Status and Liver Events Assessment(Visit 3)

Date of Visit/ Assessment (Visit 2)
Beschrijving

Date of Visit/ Assessment (Visit 2)

Alias
UMLS CUI-1
C1320303
UMLS CUI-2
C2985720
Date of Visit/ Assessment
Beschrijving

Date of Visit/ Assessment

Datatype

date

Alias
UMLS CUI [1,1]
C1320303
UMLS CUI [1,2]
C2985720
Completion of Visit Assessments (Visit 2)
Beschrijving

Completion of Visit Assessments (Visit 2)

Alias
UMLS CUI-1
C0545082
UMLS CUI-2
C0220825
UMLS CUI-3
C0205197
Were all Visit 2 assessments completed as per the protocol and confirm subject is not a run in failure?
Beschrijving

All Visit 2 assessments completed and confirm subject is not a run in failure?

Datatype

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C0220825
UMLS CUI [1,3]
C0205197
UMLS CUI [1,4]
C2348563
UMLS CUI [2,1]
C0681850
UMLS CUI [2,2]
C1710476
Run- In Failure (Visit 2)
Beschrijving

Run- In Failure (Visit 2)

Alias
UMLS CUI-1
C1710476
Was this subject a run- in failure?
Beschrijving

Was this subject a run- in failure?

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
If this subject was a run- in failure, complete run- in reason.
Beschrijving

Run- in failure reason

Datatype

integer

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C068185
UMLS CUI [1,3]
C0392360
If this subject was a run- in failure because of Investigator descretion, specify.
Beschrijving

If this subject was a run- in failure because of Investigator descretion, specify.

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
UMLS CUI [2,1]
C0008961
UMLS CUI [2,2]
C0022423
UMLS CUI [2,3]
C2348235
If this subject was a run- in failure because of Withdrew consent, specify.
Beschrijving

If this subject was a run- in failure because of Withdrew consent, specify.

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
UMLS CUI [2,1]
C1707492
UMLS CUI [2,2]
C2348235
Investigator Siganture (Visit 2)
Beschrijving

Investigator Siganture (Visit 2)

Alias
UMLS CUI-1
C2346576
Is this casebook ready to sign?
Beschrijving

Casebook ready to sign

Datatype

text

Alias
UMLS CUI [1]
C2346576
Tick or untick this box to require the investigator to sign the case book.
Beschrijving

For Data Managers or Monitors only

Datatype

integer

Alias
UMLS CUI [1]
C2346576
Date of Visit/ Assessment (Visit 3)
Beschrijving

Date of Visit/ Assessment (Visit 3)

Alias
UMLS CUI-1
C1320303
UMLS CUI-2
C2985720
Date of Visit/ Assessment
Beschrijving

Date of Visit/ Assessment

Datatype

date

Alias
UMLS CUI [1,1]
C1320303
UMLS CUI [1,2]
C2985720
Randomisation Criteria (Visit 3)
Beschrijving

Randomisation Criteria (Visit 3)

Alias
UMLS CUI-1
C0034656
UMLS CUI-2
C0243161
Did the subject meet all of the Randomisation criteria?
Beschrijving

Did the subject meet all of the Randomisation criteria?

Datatype

text

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0243161
Inclusion Criteria
Beschrijving

Inclusion Criteria

Datatype

integer

Alias
UMLS CUI [1]
C1512693
Exclucion Criteria
Beschrijving

Exclucion Criteria

Datatype

text

Alias
UMLS CUI [1]
C0680251
Run- In Failure (Visit 3)
Beschrijving

Run- In Failure (Visit 3)

Alias
UMLS CUI-1
C1710476
Was this subject a run- in failure?
Beschrijving

Was this subject a run- in failure?

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
If this subject was a run- in failure, complete run- in reason.
Beschrijving

Run- in failure reason

Datatype

integer

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C068185
UMLS CUI [1,3]
C0392360
If this subject was a run- in failure because of Investigator descretion, specify.
Beschrijving

If this subject was a run- in failure because of Investigator descretion, specify.

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
UMLS CUI [2,1]
C0008961
UMLS CUI [2,2]
C0022423
UMLS CUI [2,3]
C2348235
If this subject was a run- in failure because of Withdrew consent, specify.
Beschrijving

If this subject was a run- in failure because of Withdrew consent, specify.

Datatype

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
UMLS CUI [2,1]
C1707492
UMLS CUI [2,2]
C2348235
Investigator Siganture (Visit 3)
Beschrijving

Investigator Siganture (Visit 3)

Alias
UMLS CUI-1
C2346576
Is this casebook ready to sign?
Beschrijving

Casebook ready to sign

Datatype

text

Alias
UMLS CUI [1]
C2346576
Tick or untick this box to require the investigator to sign the case book.
Beschrijving

For Data Managers or Monitors only

Datatype

integer

Alias
UMLS CUI [1]
C2346576
ICS/ LABA Concomitant Medications (Visit 3)
Beschrijving

ICS/ LABA Concomitant Medications (Visit 3)

Alias
UMLS CUI-1
C2347852
UMLS CUI-2
C3248292
UMLS CUI-3
C0001644
What inhaled corticosteroid regimen was the subject receiving when they entered the study?
Beschrijving

Inhaled corticosteroid regimen

Datatype

integer

Alias
UMLS CUI [1]
C0586793
UMLS CUI [2,1]
C2603343
UMLS CUI [2,2]
C0337095
What specific inhaled corticosteroid did the subject take during the run- in period?
Beschrijving

What specific inhaled corticosteroid did the subject take during the run- in period?

Datatype

integer

Alias
UMLS CUI [1,1]
C0586793
UMLS CUI [1,2]
C2348235
If other inhaled corticosteroid, specify.
Beschrijving

If other inhaled corticosteroid, specify

Datatype

text

Alias
UMLS CUI [1,1]
C0586793
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C2348235
Total ICS Daily Dose During Run- in
Beschrijving

Total ICS Daily Dose During Run- in

Datatype

text

Alias
UMLS CUI [1,1]
C0586793
UMLS CUI [1,2]
C2348070
UMLS CUI [1,3]
C0439810
Randomisation Number (Visit 3)
Beschrijving

Randomisation Number (Visit 3)

Alias
UMLS CUI-1
C0034656
UMLS CUI-2
C0237753
Randomisation Number
Beschrijving

Randomisation Number

Datatype

text

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Date of Randomisation
Beschrijving

Date of Randomisation

Datatype

date

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0011008
Investigatinal Product (Visit 3)
Beschrijving

Investigatinal Product (Visit 3)

Alias
UMLS CUI-1
C0304229
Time of PM clinic visit dose
Beschrijving

Time of PM clinic visit dose

Datatype

time

Alias
UMLS CUI [1,1]
C0008952
UMLS CUI [1,2]
C0178602
UMLS CUI [1,3]
C0040223
Vital Signs (Visit 3)
Beschrijving

Vital Signs (Visit 3)

Alias
UMLS CUI-1
C0518766
Actual date/ time
Beschrijving

Actual date/ time

Datatype

datetime

Alias
UMLS CUI [1]
C1264639
Blood pressure (systolic/ diastolic)
Beschrijving

Blood pressure

Datatype

text

Maateenheden
  • mmHg
Alias
UMLS CUI [1]
C0005823
mmHg
Subject position
Beschrijving

Position must be consistent throughout the study.

Datatype

integer

Alias
UMLS CUI [1]
C1262869
Heart rate
Beschrijving

Heart rate

Datatype

integer

Maateenheden
  • beats/min
Alias
UMLS CUI [1]
C0018810
beats/min
Temperature
Beschrijving

Temperature

Datatype

float

Maateenheden
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Respiration rate
Beschrijving

Respiration rate

Datatype

integer

Maateenheden
  • breaths/min
Alias
UMLS CUI [1]
C0231832
breaths/min
Calculated Subject position
Beschrijving

Calculated Subject position

Datatype

text

Alias
UMLS CUI [1,1]
C1262869
UMLS CUI [1,2]
C0444686
Candidiasis Examination (Visit 3)
Beschrijving

Candidiasis Examination (Visit 3)

Alias
UMLS CUI-1
C0006840
UMLS CUI-2
C4321457
Does the subject have clinical visual evidence of oropharyngeal candidiasis?
Beschrijving

Oropharyngeal candidiasis

Datatype

boolean

Alias
UMLS CUI [1]
C0919659
Electronically transferred lab data (Visit 3)
Beschrijving

Electronically transferred lab data (Visit 3)

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C1320722
Urine Cortisol Date sample taken
Beschrijving

Urine Cortisol Date sample taken

Datatype

date

Alias
UMLS CUI [1,1]
C1302413
UMLS CUI [1,2]
C0474662
Haem Lab type code
Beschrijving

Haem Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0018941
UMLS CUI [1,2]
C0805701
Chem Lab type code
Beschrijving

Chem Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0005774
UMLS CUI [1,2]
C0805701
Urin Lab type code
Beschrijving

Urin Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0042014
UMLS CUI [1,2]
C0805701
Device Use Assessment (Visit 3)
Beschrijving

Device Use Assessment (Visit 3)

Alias
UMLS CUI-1
C0699733
UMLS CUI-2
C1524063
UMLS CUI-3
C0220825
Did the subject use the device correctly?
Beschrijving

Did the subject use the device correctly?

Datatype

boolean

Alias
UMLS CUI [1,1]
C0699733
UMLS CUI [1,2]
C1524063
UMLS CUI [1,3]
C2349182
If subject does not use the device correctly, what did subject do incorrectly?
Beschrijving

If subject does not use the device correctly, what did subject do incorrectly?

Datatype

integer

Alias
UMLS CUI [1]
C3544346
If subject does not use the device correctly, record number of times subject required additional instruction.
Beschrijving

Number of times subject required additional instruction

Datatype

integer

Alias
UMLS CUI [1]
C3544346
UMLS CUI [2,1]
C1442085
UMLS CUI [2,2]
C1524062
UMLS CUI [2,3]
C0237753
Subject Withdrawal Status (Visit 3)
Beschrijving

Subject Withdrawal Status (Visit 3)

Alias
UMLS CUI-1
C0422727
UMLS CUI-2
C0449438
Did the subject withdraw at this visit?
Beschrijving

Did the subject withdraw at this visit?

Datatype

boolean

Alias
UMLS CUI [1]
C1710677
UMLS CUI [2]
C0545082
Electronically transferred lab data (Visit 3)
Beschrijving

Electronically transferred lab data (Visit 3)

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C1320722
Date Sample(s) Taken
Beschrijving

Date Sample(s) Taken

Datatype

date

Alias
UMLS CUI [1]
C1302413
Haem Lab type code
Beschrijving

Haem Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0018941
UMLS CUI [1,2]
C0022877
UMLS CUI [1,3]
C0805701
Chem Lab type code
Beschrijving

Chem Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0005774
UMLS CUI [1,2]
C0022877
UMLS CUI [1,3]
C0805701
Urin Lab type code
Beschrijving

Urin Lab type code

Datatype

text

Alias
UMLS CUI [1,1]
C0042014
UMLS CUI [1,2]
C0022877
UMLS CUI [1,3]
C0805701
Liver Events Assessment (Visit 3)
Beschrijving

Liver Events Assessment (Visit 3)

Alias
UMLS CUI-1
C0023884
UMLS CUI-2
C0877248
UMLS CUI-3
C0220825
Was there a protocol defined liver chemistry event for the lab samples collected at this visit?
Beschrijving

Liver chemistry event for the lab samples collected at this visit

Datatype

boolean

Alias
UMLS CUI [1,1]
C0008000
UMLS CUI [1,2]
C0023884
UMLS CUI [1,3]
C0877248
UMLS CUI [2,1]
C0005834
UMLS CUI [2,2]
C0545082
Specify type of liver chemistry event.
Beschrijving

Specify type of liver chemistry event

Datatype

integer

Alias
UMLS CUI [1,1]
C0008000
UMLS CUI [1,2]
C0023884
UMLS CUI [1,3]
C0877248
UMLS CUI [1,4]
C2348235

Similar models

Visit Assessments Complete (Visit 2) and Run-In-Failure, Randomisation Criteria, ICS/ LABA Concomitant Medications, Randomisation Number, Investigational Product, Vital Signs, Electronically Transferred Lab Data, Device Use Assessment, Subject Withdrawal Status and Liver Events Assessment(Visit 3)

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Date of Visit/ Assessment (Visit 2)
C1320303 (UMLS CUI-1)
C2985720 (UMLS CUI-2)
Date of Visit/ Assessment
Item
Date of Visit/ Assessment
date
C1320303 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Item Group
Completion of Visit Assessments (Visit 2)
C0545082 (UMLS CUI-1)
C0220825 (UMLS CUI-2)
C0205197 (UMLS CUI-3)
All Visit 2 assessments completed and confirm subject is not a run in failure?
Item
Were all Visit 2 assessments completed as per the protocol and confirm subject is not a run in failure?
boolean
C0545082 (UMLS CUI [1,1])
C0220825 (UMLS CUI [1,2])
C0205197 (UMLS CUI [1,3])
C2348563 (UMLS CUI [1,4])
C0681850 (UMLS CUI [2,1])
C1710476 (UMLS CUI [2,2])
Item Group
Run- In Failure (Visit 2)
C1710476 (UMLS CUI-1)
Item
Was this subject a run- in failure?
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
Code List
Was this subject a run- in failure?
CL Item
No (N)
CL Item
Yes, complete run- in reason (Y)
Item
If this subject was a run- in failure, complete run- in reason.
integer
C1710476 (UMLS CUI [1,1])
C068185 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Code List
If this subject was a run- in failure, complete run- in reason.
CL Item
Adverse Event (Record details on the Non- Serious Adverse Event or Serious Adverse Events forms as appropriate.) (1)
CL Item
Protocol Deviation (3)
CL Item
Study closed/ terminated (5)
CL Item
Lost to Follow- up (6)
CL Item
Investigator discretion, specify (7)
CL Item
Withdrew consent, specify (8)
CL Item
Did not meet continuation criteria (9)
If this subject was a run- in failure because of Investigator descretion, specify.
Item
If this subject was a run- in failure because of Investigator descretion, specify.
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0008961 (UMLS CUI [2,1])
C0022423 (UMLS CUI [2,2])
C2348235 (UMLS CUI [2,3])
If this subject was a run- in failure because of Withdrew consent, specify.
Item
If this subject was a run- in failure because of Withdrew consent, specify.
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C1707492 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
Item Group
Investigator Siganture (Visit 2)
C2346576 (UMLS CUI-1)
Item
Is this casebook ready to sign?
text
C2346576 (UMLS CUI [1])
Code List
Is this casebook ready to sign?
CL Item
Yes (Y)
Item
Tick or untick this box to require the investigator to sign the case book.
integer
C2346576 (UMLS CUI [1])
Code List
Tick or untick this box to require the investigator to sign the case book.
CL Item
Sign (1)
Item Group
Date of Visit/ Assessment (Visit 3)
C1320303 (UMLS CUI-1)
C2985720 (UMLS CUI-2)
Date of Visit/ Assessment
Item
Date of Visit/ Assessment
date
C1320303 (UMLS CUI [1,1])
C2985720 (UMLS CUI [1,2])
Item Group
Randomisation Criteria (Visit 3)
C0034656 (UMLS CUI-1)
C0243161 (UMLS CUI-2)
Item
Did the subject meet all of the Randomisation criteria?
text
C0034656 (UMLS CUI [1,1])
C0243161 (UMLS CUI [1,2])
Code List
Did the subject meet all of the Randomisation criteria?
CL Item
Yes (Y)
CL Item
No, please select all boxes corresponding to violations of any randomzation criteria (N)
Item
Inclusion Criteria
integer
C1512693 (UMLS CUI [1])
Code List
Inclusion Criteria
CL Item
Evening pre- dose FEV1 of between 40% and 90% of their predicted normal at Visit 3. (1)
CL Item
Demonstrated and reported in an eDiary, symptoms of asthma (a score of >=1 on day- time or night- time asthma symptom scores) and/ or daily albuterol/ salbutamol use on >= 4 od the last consecutive days of the run- in period. (2)
CL Item
Subjects recorded the use of run- in asthma controller medication on >= 4 of the last 7 consecutive days of the run- in period (3)
CL Item
Compliance with completion of the Daily Diary reporting defined as completion of all questions on >= 4 of the last 7 consecutive days of the run- in period. (4)
Item
Exclucion Criteria
text
C0680251 (UMLS CUI [1])
Code List
Exclucion Criteria
CL Item
Evidence of clinically significant abnormal laboratory tests during Visit 1 which are still abnormal upon repeat analysis and are not believed to be due to disease(s) present. Each Investigator will use his/ her own discretion in determining the clinical significance of the abnormality. (1)
CL Item
Changes in asthma medication (excluding albuterol/ salbutamol inhalation aerosol provided at Visit 1). (2)
CL Item
Occurence of a culture- documented or suspected bacterial or viral infection of the upper or lower respiratory tract, sinus or middle ear during the run- in period that led to a change in asthma management or, in the opinion of the Investigator, is expected to affect the subjects asthma status or the subjects ability to participate the study. (3)
CL Item
Evidence of significant abnormality in the 12- lead ECG performed at Visit 2 and/ or Visit 3 (in the subsent of subjects undergoing ECGs at Visit 3). Selected specific ECG findings that are considered to be significant and will exclude the subject from study participation include, but are not limited to, the following: (4)
CL Item
- Sinus bradycardia <45bpm (5)
CL Item
110bpm (- Sinus tachycardia >)
CL Item
- Multifocal atrial tachycardia (wandering atrial pacemaker with rate >100bpm) (7)
CL Item
- PR interval >240msec (8)
CL Item
- Evidence of Mobitz II second degree or third degree atrioventricular (AV) block (9)
CL Item
- Pathological Q waves (defined as wide [>0.04 seconds] and deep [>0.4mV (4mm with 10mm/mV setting)] or >25% of the height of the corresponding R wave, provicing the R wave was >0.5mV [5mm with 10mm/mV setting], appearing in at least two contiguous leads. (10)
CL Item
Note: prior evidence (i.e., ECG obtained at last 12 months prior) of pathological Q waves that are unchanged are not exclusionary. (11)
CL Item
- Evidence of ventricular ectopic couplets, bigeminy, trigeminy or multifocal premature ventricular complexes. (12)
CL Item
450msec or an ECG that is unsuitable for QT measurements (e.g., poor defined termination of the T wave). Subjects with right bundle branch block should be excluded if the QTc(F) is >= 480msec. (- QTc(F) >)
CL Item
450msec, or >=480 in subjects with right bundle branch block, should be confirmed by three readings at least 5 minutes apart. (Note: QTc(F) >)
CL Item
- ST- T wave abnormalities (excluding non-specific ST- T wave abnormalities) (15)
CL Item
- Bifascicular block (i.e. Complete left bundle branch block [CLBBB] or complete right bundle branch block with concomitant left fascicular block) (16)
CL Item
- Clinically significant conduction abnormalities (e.g.. left bundle branch block, Wollf- Parkinson-White syndrome) (17)
CL Item
- Clinically significant arrhiythmias (e.g., atrial fibrillation with rapid ventricular response, ventricular tachycardia) (18)
CL Item
Evidence of a severe exacerbation, defined as deterioration of asthma requiring the use of systemic corticoidsteroids (tablets, suspension, or injection) for at least 3 days or an in- patient hospitalization or emergency department visit due to asthma that required systemic corticosteroids between Visits 1 and 3. (5)
CL Item
Clinical visual evidence of oral candidiasis at the Randomization Visit (Visit3). (6)
CL Item
Subject is unable to use the inhaler correctly after 3 seperate demonstrations at Randomisation Visit (Visist 3). (7)
Item Group
Run- In Failure (Visit 3)
C1710476 (UMLS CUI-1)
Item
Was this subject a run- in failure?
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
Code List
Was this subject a run- in failure?
CL Item
No  (N)
CL Item
Yes, complete run- in reason (Y)
Item
If this subject was a run- in failure, complete run- in reason.
integer
C1710476 (UMLS CUI [1,1])
C068185 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Code List
If this subject was a run- in failure, complete run- in reason.
CL Item
Adverse Event (Record details on the Non- Serious Adverse Event or Serious Adverse Events forms as appropriate.) (1)
CL Item
Protocol Deviation (3)
CL Item
Study closed/ terminated (5)
CL Item
Lost to Follow- up (6)
CL Item
Investigator discretion, specify (7)
CL Item
Withdrew consent, specify (8)
CL Item
Did not meet continuation criteria (9)
If this subject was a run- in failure because of Investigator descretion, specify.
Item
If this subject was a run- in failure because of Investigator descretion, specify.
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0008961 (UMLS CUI [2,1])
C0022423 (UMLS CUI [2,2])
C2348235 (UMLS CUI [2,3])
If this subject was a run- in failure because of Withdrew consent, specify.
Item
If this subject was a run- in failure because of Withdrew consent, specify.
text
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C1707492 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
Item Group
Investigator Siganture (Visit 3)
C2346576 (UMLS CUI-1)
Item
Is this casebook ready to sign?
text
C2346576 (UMLS CUI [1])
Code List
Is this casebook ready to sign?
CL Item
Yes (Y)
Item
Tick or untick this box to require the investigator to sign the case book.
integer
C2346576 (UMLS CUI [1])
Code List
Tick or untick this box to require the investigator to sign the case book.
CL Item
Sign (1)
Item Group
ICS/ LABA Concomitant Medications (Visit 3)
C2347852 (UMLS CUI-1)
C3248292 (UMLS CUI-2)
C0001644 (UMLS CUI-3)
Item
What inhaled corticosteroid regimen was the subject receiving when they entered the study?
integer
C0586793 (UMLS CUI [1])
C2603343 (UMLS CUI [2,1])
C0337095 (UMLS CUI [2,2])
Code List
What inhaled corticosteroid regimen was the subject receiving when they entered the study?
CL Item
ICS alone (1)
CL Item
ICS + salmeterol (2)
CL Item
ICS + formoterol (3)
Item
What specific inhaled corticosteroid did the subject take during the run- in period?
integer
C0586793 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Code List
What specific inhaled corticosteroid did the subject take during the run- in period?
CL Item
Fluticasone proprionate (1)
CL Item
Beclomethasone diproprionate (2)
CL Item
Budenoside (3)
CL Item
Flunisolide (4)
CL Item
Triamcenolone acetonide (5)
CL Item
Mometasone fuorate (6)
CL Item
Ciclesonide (7)
CL Item
Other inhaled corticodsteroid, specify (8)
If other inhaled corticosteroid, specify
Item
If other inhaled corticosteroid, specify.
text
C0586793 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Total ICS Daily Dose During Run- in
Item
Total ICS Daily Dose During Run- in
text
C0586793 (UMLS CUI [1,1])
C2348070 (UMLS CUI [1,2])
C0439810 (UMLS CUI [1,3])
Item Group
Randomisation Number (Visit 3)
C0034656 (UMLS CUI-1)
C0237753 (UMLS CUI-2)
Randomisation Number
Item
Randomisation Number
text
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Date of Randomisation
Item
Date of Randomisation
date
C0034656 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Investigatinal Product (Visit 3)
C0304229 (UMLS CUI-1)
Time of PM clinic visit dose
Item
Time of PM clinic visit dose
time
C0008952 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Item Group
Vital Signs (Visit 3)
C0518766 (UMLS CUI-1)
Actual date/ time
Item
Actual date/ time
datetime
C1264639 (UMLS CUI [1])
Blood pressure
Item
Blood pressure (systolic/ diastolic)
text
C0005823 (UMLS CUI [1])
Item
Subject position
integer
C1262869 (UMLS CUI [1])
Code List
Subject position
CL Item
Supine (1)
CL Item
Sitting (2)
CL Item
Standing (3)
CL Item
Semi- supine (4)
Heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Temperature
Item
Temperature
float
C0005903 (UMLS CUI [1])
Respiration rate
Item
Respiration rate
integer
C0231832 (UMLS CUI [1])
Calculated Subject position
Item
Calculated Subject position
text
C1262869 (UMLS CUI [1,1])
C0444686 (UMLS CUI [1,2])
Item Group
Candidiasis Examination (Visit 3)
C0006840 (UMLS CUI-1)
C4321457 (UMLS CUI-2)
Oropharyngeal candidiasis
Item
Does the subject have clinical visual evidence of oropharyngeal candidiasis?
boolean
C0919659 (UMLS CUI [1])
Item Group
Electronically transferred lab data (Visit 3)
C0022885 (UMLS CUI-1)
C1320722 (UMLS CUI-2)
Urine Cortisol Date sample taken
Item
Urine Cortisol Date sample taken
date
C1302413 (UMLS CUI [1,1])
C0474662 (UMLS CUI [1,2])
Haem Lab type code
Item
Haem Lab type code
text
C0018941 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Chem Lab type code
Item
Chem Lab type code
text
C0005774 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Urin Lab type code
Item
Urin Lab type code
text
C0042014 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Item Group
Device Use Assessment (Visit 3)
C0699733 (UMLS CUI-1)
C1524063 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
Did the subject use the device correctly?
Item
Did the subject use the device correctly?
boolean
C0699733 (UMLS CUI [1,1])
C1524063 (UMLS CUI [1,2])
C2349182 (UMLS CUI [1,3])
Item
If subject does not use the device correctly, what did subject do incorrectly?
integer
C3544346 (UMLS CUI [1])
Code List
If subject does not use the device correctly, what did subject do incorrectly?
CL Item
Open the device (1)
CL Item
Inhale the device (2)
CL Item
Close the device (3)
Item
If subject does not use the device correctly, record number of times subject required additional instruction.
integer
C3544346 (UMLS CUI [1])
C1442085 (UMLS CUI [2,1])
C1524062 (UMLS CUI [2,2])
C0237753 (UMLS CUI [2,3])
Code List
If subject does not use the device correctly, record number of times subject required additional instruction.
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
>3 (4)
Item Group
Subject Withdrawal Status (Visit 3)
C0422727 (UMLS CUI-1)
C0449438 (UMLS CUI-2)
Did the subject withdraw at this visit?
Item
Did the subject withdraw at this visit?
boolean
C1710677 (UMLS CUI [1])
C0545082 (UMLS CUI [2])
Item Group
Electronically transferred lab data (Visit 3)
C0022885 (UMLS CUI-1)
C1320722 (UMLS CUI-2)
Date Sample(s) Taken
Item
Date Sample(s) Taken
date
C1302413 (UMLS CUI [1])
Haem Lab type code
Item
Haem Lab type code
text
C0018941 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Chem Lab type code
Item
Chem Lab type code
text
C0005774 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Urin Lab type code
Item
Urin Lab type code
text
C0042014 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
C0805701 (UMLS CUI [1,3])
Item Group
Liver Events Assessment (Visit 3)
C0023884 (UMLS CUI-1)
C0877248 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
Liver chemistry event for the lab samples collected at this visit
Item
Was there a protocol defined liver chemistry event for the lab samples collected at this visit?
boolean
C0008000 (UMLS CUI [1,1])
C0023884 (UMLS CUI [1,2])
C0877248 (UMLS CUI [1,3])
C0005834 (UMLS CUI [2,1])
C0545082 (UMLS CUI [2,2])
Item
Specify type of liver chemistry event.
integer
C0008000 (UMLS CUI [1,1])
C0023884 (UMLS CUI [1,2])
C0877248 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Code List
Specify type of liver chemistry event.
CL Item
Liver Event Monitoring Criteria (subject has met protocol defined liver event monitoring criteria). Obtain tests as per protocol. (1)
CL Item
Liver Event Stopping Criteria (subject has met protocol defined liver event stopping criteria, has been monitored for the protocol specified time period and continues to meet liver chemistry monitoring criteria). Stop investigational product, complete date stopped on Investigational Product Form and contact GSK within 24 hours of occurence of liver event by phone or fax. NOTE: If the liver event meets the definition of an SAE, the SAE form must be completed in InForm. If InForm is unavailable, the SAE form should be faxed to GSK. (2)

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