Motivational interviewing and air cleaners for smokers with COPD (MOVE COPD)

针对慢性阻塞性肺病吸烟者的动机访谈和空气净化器 (MOVE COPD)

• 批准号: 10424537
• 负责人: Nadia N Hansel
• 金额: $ 62.73万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424537
• 关键词: Air; Air Pollution; Behavior Therapy; Behavioral; Biomass; Carbon; Cause of Death; Chronic Disease; Chronic Obstructive Pulmonary Disease; Clinical Practice Guideline; Communities; Conduct Clinical Trials; Counseling; Epidemiology; Exposure to; Family; Gases; Guidelines; Habits; Harm Reduction; Health; Health Benefit; Health Policy; Health Promotion; Health behavior change; Home; Individual; Indoor Air Pollution; Indoor Air Quality; Indoor environment; Inflammation; Intervention; Intervention Studies; Intervention Trial; Link; Lung diseases; Mechanics; Methods; Modification; Morbidity - disease rate; Nicotine; Nitrogen Dioxide; Outcome; Outcome Measure; Oxidative Stress; Participant; Particulate Matter; Patients; Persons; Progressive Disease; Pulmonary Inflammation; Quality of life; Randomized; Recommendation; Research; Risk; Running; Serum; Smoke; Smoker; Smoking; Smoking Status; Sputum; Symptoms; Testing; Time; United States; Update; Urine; air cleaner; airway inflammation; burden of illness; cigarette smoke; clinical practice; economic cost; environmental intervention; environmental tobacco smoke; experience; former smoker; high risk; improved; improved outcome; indoor exposure; indoor particulate matter; indoor pollutant; lung injury; mortality; motivational enhancement therapy; multi-component intervention; nicotine replacement; particle; pollutant; portability; pulmonary function; respiratory; respiratory health; respiratory morbidity; smoking cessation; systemic inflammatory response; theories

COPD is characterized by lung injury and inflammation caused by noxious particles and gases, including those emanating from cigarette smoke and air pollution. Unfortunately, current active smokers represent the largest subset of COPD in the US and most individuals with COPD are not successful at quitting even though smoking cessation is the best option. A potential harm reduction strategy for those who will not or have not yet successfully quit, that has not been tested and has no health risk, is improvement of air quality. The indoor environment is of particular concern as patients with moderate to severe COPD spend the majority of their time in their homes. People with COPD who have higher exposure to indoor pollutants, including particulate matter (PM), second hand smoke (SHS), and nitrogen dioxide (NO2) have worse respiratory morbidity including a higher risk of exacerbations. These effects are not obscured by their smoking habit. Unfortunately, despite the clear detrimental impact of poor air quality on respiratory outcomes, regardless of smoking status, to our knowledge, there are no studied environmental interventions targeting indoor air quality to improve respiratory health of smokers, thus ignoring a potential target for harm reduction. Our group has substantial expertise in conducting trials successful at reducing harmful indoor exposures including 1) home interventions utilizing portable air cleaners with high efficiency particular air and carbon filters that significantly reduce indoor PM and NO2 concentrations, and 2) behavioral interventions including Motivational Interviewing (MI) to promote health behavior change and reduce home air nicotine levels and indoor SHS. We propose a randomized controlled intervention trial to test whether targeted reductions of multiple indoor pollutants (PM, SHS and NO2) in homes of smokers with COPD will improve respiratory outcomes. We have chosen a potent, multimodal intervention in order to maximize the opportunity to prove that there is a health benefit to active smokers with COPD from indoor air pollution reduction. After a one-month run in period in which all participants will receive smoking cessation strategies including MI and nicotine replacement therapy, participants unable to quit smoking (n=120) will have 1:1 randomization to receive either 1) multi-component environmental intervention (active air cleaners + MI intervention for SHS reduction) or 2) sham air cleaners. All participants will continue to receive smoking cessation counseling throughout the study period, including those that quit smoking during the run in period. We aim to determine whether a multi-component environmental intervention (targeting PM, SHS and NO2 reduction) will improve respiratory morbidity (i.e., symptoms, quality of life, lung function and exacerbation risk) (Specific Aim #1) and intermediate outcome measures (i.e., markers of airway and systemic inflammation and oxidative stress) (Specific Aim #2) in smokers with COPD. We anticipate that results from this study will inform clinical practice guidelines and health care policies aimed at reducing COPD morbidity and may have broader implications for indoor environmental recommendations for smokers with chronic disease. 1

COPD的特征是肺损伤和由有害颗粒和气体引起的炎症，包括 从香烟烟雾和空气污染中发出。不幸的是，目前的活跃吸烟者是最大的 美国和大多数患有COPD的人的COPD子集即使吸烟也没有成功戒烟 戒烟是最好的选择。对于那些尚未或尚未的人来说，潜在的减少危害策略 成功戒烟，尚未经过测试，没有健康风险，是空气质量的改善。室内 环境特别关注，因为中度至重度COPD的患者大部分时间都花费 在他们的家中。患有更高接触室内污染物的COPD的人，包括颗粒物 （PM），二手烟（SHS）和二氧化氮（NO2）的呼吸发病率较差，包括 加重的风险更高。这些影响不会被吸烟习惯所掩盖。不幸的是，尽管有 空气质量差的明显有害影响对我们的呼吸系统结果，无论吸烟状况如何 知识，没有针对室内空气质量的研究环境干预措施来改善呼吸系统 吸烟者的健康，因此忽略了减少伤害的潜在目标。我们的小组在 进行成功减少有害室内暴露的试验，包括1）使用的家庭干预措施 具有高效率的便携式空气清洁剂，特殊的空气和碳过滤器，可显着降低室内PM和 NO2浓度和2）包括动机访谈（MI）在内的行为干预措施以促进健康 行为改变并降低家庭空气尼古丁水平和室内shs。我们提出了一个随机控制的 干预试验以测试房屋中有针对性减少多种室内污染物（PM，SHS和NO2） 患有COPD的吸烟者将改善呼吸系统效果。我们选择了有效的多模式干预 为了最大化机会证明有健康吸烟者的健康受益者 室内空气污染减少。经过一个月的时间，所有参与者都会接受吸烟 戒烟策略包括MI和Nicotine替代疗法，参与者无法戒烟 （n = 120）将有1：1随机分组以接收1）多组分环境干预（主动空气 清洁剂 + MI减少的干预）或2）假空气清洁剂。所有参与者将继续收到 在整个研究期间，吸烟戒烟咨询，包括那些在跑步期间戒烟的咨询 时期。我们旨在确定多组分的环境干预是否（针对PM，SHS和 降低NO2）将改善呼吸发病率（即症状，生活质量，肺功能和恶化 风险）（特定目的＃1）和中级结果指标（即气道和全身发炎的标记 和COPD吸烟者中的氧化应激（特定目标＃2）。我们预计这项研究的结果将会 为旨在降低COPD发病率的临床实践指南和医疗保健政策提供信息 对慢性疾病吸烟者的室内环境建议的更广泛影响。 1