Environmental Impact on Exacerbations, Chronic Symptoms, and QOL in COPD Patients

环境对 COPD 患者病情加重、慢性症状和生活质量的影响

• 批准号: 8046261
• 负责人: Vincent S Fan
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8046261
• 关键词: Accounting; Air; Air Pollution; Bronchitis; Carbon; Characteristics; Chronic; Chronic Obstructive Airway Disease; Cities; Counseling; Data; Disease; Disease Outcome; Education; Enrollment; Environment; Environmental Impact; Exposure to; Funding; Goals; Hospitalization; Intervention; Lead; Link; Lung; Measurement; Mediating; Methods; Modeling; Nitrogen Dioxide; Outcome; Outpatients; Ozone; Particulate Matter; Patients; Phase; Physical Function; Physical activity; Pollution; Population; Predisposition; Prevalence; Provider; Pulmonary Emphysema; Quality of life; Randomized Clinical Trials; Rehabilitation therapy; Research; Respiratory Tract Infections; Risk; Self Management; Severity of illness; Smoke; Socioeconomic Status; Sulfur Dioxide; Symptoms; Time; Training; United States; Veterans; Viral; Walking; experience; follow-up; health related quality of life; improved; patient population; pollutant; prevent; programs; respiratory

DESCRIPTION (provided by applicant): The prevalence of COPD approaches 22% of the Veteran population, and patients with severe COPD experience an average of 2.5 exacerbations per year. COPD exacerbations can be triggered by both bacterial and viral respiratory infections, however increasing evidence suggests that air pollution is also a cause. Prior studies examining the relationship between air pollution and hospitalization rates have been ecologic studies at the city level, and have not controlled for patient-level characteristics such as disease severity, and focused only on the most severe exacerbations that lead to hospitalizations. Few studies have evaluated the relationship between outdoor ambient air pollution and important COPD outcomes such as chronic symptoms, health- related quality of life or physical activity. The overall purpose of this study is to examine the impact of outdoor air pollution on risk of exacerbations, health related quality of life and physical function among patients with COPD. Specific aims: The goal of this proposal are to: 1) examine whether chronic exposure to outdoor air pollution is associated with exacerbations and respiratory symptoms among COPD patients, and 2) determine whether outdoor air pollution is associated with worse COPD-specific health-related quality of life and decreased physical activity. Methods: We propose an additional year of follow-up for COPD patients currently enrolled in VA CSP #560 (BREATH), a multicenter randomized clinical trial of a comprehensive self-management intervention that enrolled 425 patients. The study is currently in observational phase set to end September 30, 2010. The proposed research is an opportunity to continue to follow this unique and well-characterized population with moderate to severe COPD in order to collect additional data on patient exacerbations, physical activity, and HRQOL. Patient-level data will be linked to air pollution data and data regarding the built environment including walk ability and time spent outdoors. Previously assessed information on COPD symptoms/outcomes and HRQOL will be combined with an additional year of measurements on patients' COPD symptoms/outcomes, HRQOL, physical activity, air pollution, and built environment. Mixed effects Poisson regression models will be employed to examine the associations between (1) air pollution and exacerbations rates and the interaction between pollution and the built environment, and (2) air pollution and COPD-specific and general HRQOL as well as physical activity. Models will be adjusted for important covariates including socioeconomic status and COPD disease severity. Conclusions: The results of the proposed study will greatly advance our understanding of the impact of ambient air pollution on exacerbations, HRQOL and PA. The results will provide data to counsel patients, improve self-management programs and to better develop interventions to increase physical activity and improve quality of life in COPD. PUBLIC HEALTH RELEVANCE: Self-management programs may decrease exacerbations and improve HRQOL in COPD among Veterans, and improving patient physical activity through pulmonary rehabilitation is considered a key component of the treatment of COPD. Self- management education is a integral part to helping COPD patients manage their disease and prevent exacerbations. Understanding the impact of air pollution on exacerbations, HRQOL and physical activity will enable providers to better counsel patients, and provide data to guide interventions to improve physical activity among Veterans with COPD.

描述（由申请人提供）： 退伍军人群体中 COPD 的患病率接近 22%，严重 COPD 患者每年平均会出现 2.5 次病情加重。细菌和病毒呼吸道感染都可能引发慢性阻塞性肺病（COPD）恶化，但越来越多的证据表明空气污染也是一个原因。先前检查空气污染与住院率之间关系的研究都是城市层面的生态研究，并没有控制疾病严重程度等患者层面的特征，并且只关注导致住院的最严重的恶化。很少有研究评估室外环境空气污染与重要的慢性阻塞性肺病结局（如慢性症状、健康相关的生活质量或体力活动）之间的关系。本研究的总体目的是探讨室外空气污染对慢性阻塞性肺病患者病情加重风险、健康相关生活质量和身体功能的影响。具体目标：本提案的目标是：1) 检查慢性暴露于室外空气污染是否与慢性阻塞性肺病患者的病情加重和呼吸道症状有关，2) 确定室外空气污染是否与慢性阻塞性肺病特定健康相关状况恶化有关生活质量和体力活动减少。方法：我们建议对目前参加 VA CSP #560 (BREATH) 的 COPD 患者再进行一年的随访，这是一项综合自我管理干预措施的多中心随机临床试验，招募了 425 名患者。该研究目前处于观察阶段，预计将于 2010 年 9 月 30 日结束。拟议的研究是一个机会，可以继续跟踪这一独特且特征明确的中度至重度 COPD 人群，以收集有关患者病情加重、体力活动、和HRQOL。患者层面的数据将与空气污染数据和建筑环境数据（包括步行能力和户外时间）相关联。先前评估的有关 COPD 症状/结果和 HRQOL 的信息将与额外一年对患者 COPD 症状/结果、HRQOL、体力活动、空气污染和建筑环境的测量相结合。将采用混合效应泊松回归模型来检查（1）空气污染和恶化率以及污染与建筑环境之间的相互作用，以及（2）空气污染与慢性阻塞性肺病特定和一般HRQOL以及体力活动之间的关联。模型将根据重要的协变量进行调整，包括社会经济状况和慢性阻塞性肺病疾病的严重程度。结论：本研究的结果将极大地促进我们对环境空气污染对病情加重、HRQOL 和 PA 影响的理解。研究结果将为患者提供数据咨询、改善自我管理计划以及更好地制定干预措施以增加身体活动并改善慢性阻塞性肺病患者的生活质量。 公共卫生相关性： 自我管理计划可以减少退伍军人慢性阻塞性肺病的恶化并改善其HRQOL，并且通过肺康复改善患者的身体活动被认为是慢性阻塞性肺病治疗的关键组成部分。自我管理教育是帮助慢性阻塞性肺病患者管理疾病和预防病情恶化的重要组成部分。了解空气污染对病情加重、HRQOL 和身体活动的影响将使提供者能够更好地为患者提供咨询，并提供数据来指导干预措施，以改善患有慢性阻塞性肺病的退伍军人的身体活动。