Location and timing of inhaler use, exacerbations and physical activity in COPD

COPD 患者使用吸入器的地点和时间、病情加重和体力活动

• 批准号: 8088700
• 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: 2011-10-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8088700
• 关键词: Accident and Emergency department; Acute; Address; Adrenal Cortex Hormones; Affect; Agonist; Air Pollution; Albuterol; Antibiotics; Behavior Therapy; Bronchodilator Agents; Chronic; Chronic Obstructive Airway Disease; Coughing; Data; Data Analyses; Data Collection; Development; Devices; Diagnosis; Dyspnea; Environmental Exposure; Environmental Risk Factor; Exercise; Exercise Tolerance; Future; Goals; Guidelines; Healthcare Systems; Home environment; Hospitalization; Humidity; Infection; Information Systems; Inhalators; Intervention; Link; Location; Lung; Measurement; Measures; Meteorology; Metered Dose Inhaler Device; Methods; Monitor; Movement; Observational Study; Outpatients; Participant; Patient Participation; Patients; Pharmaceutical Preparations; Physical Function; Physical activity; Physicians; Pilot Projects; Population; Positioning Attribute; Prevention; Production; Progressive Disease; Provider; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Questionnaires; Recording of previous events; Rehabilitation therapy; Relative (related person); Shortness of Breath; Spirometry; Sputum; Symptoms; System; Temperature; Testing; Time; United States Environmental Protection Agency; Veterans; Viral; Visit; asthma inhaler; base; care seeking; compliance behavior; diaries; disability; experience; health related quality of life; improved; improved functioning; instrument; monitoring device; mortality; novel; prevent; programs; respiratory; response; sound; statistics; time use; tool

DESCRIPTION (provided by applicant): Chronic Obstructive Pulmonary Disease (COPD) affects up to 20% of VA patients and is associated with poor health-related quality of life, frequent exacerbations, and disability. Physical activity (PA) is recommended for COPD patients, however PA may be affected by exacerbations and worsening respiratory symptoms triggered by environmental factors such as air pollution and changes in temperature. Increased use of short acting beta- agonist bronchodilator use may reflect transient worsening symptoms in the setting of an acute environmental exposure, a mild exacerbation, or the beginning of a moderate or severe exacerbation. A recently developed global positioning system (GPS)-enabled inhaler permits monitoring of both location and timing of bronchodilator use. Measuring increased beta-agonist use with the GPS-enabled inhaler is a novel method to measure mild exacerbations and will allow a better understanding of environmental factors that worsen COPD and interfere with PA. The study specific aims are: Aim 1: To capture worsening respiratory symptoms and mild exacerbations with a global positioning system (GPS)-enabled short-acting beta-agonist (SABA) inhaler device. Aim 2: To characterize PA in patients with COPD using pedometers and a Physical Activity Checklist. Aim 3: To examine whether environmental triggers (air pollution, temperature, relative humidity) are linked to mild exacerbations as measured by GPS-enabled SABA inhaler device. The proposed study will be a longitudinal observational study of 40 Veterans with moderate to severe COPD. Participants diagnosed with COPD from the VA Puget Sound Health Care System will be asked to participate if they have an FEV1/FVC between 0.3 and 0.7 on spirometry and are using a short-acting bronchodilator (e.g., albuterol) delivered by metered-dose inhaler (MDI). The GPS-enabled monitoring device will be placed on top of the patient's MDI canister to record the time and location of MDI use. Participants will be followed for a total of 12 weeks. Data ascertained from the study will include daily measurements of inhaler use (time, location), daily movements (GPS monitoring every 30 minutes), and daily pedometer measurements of steps taken. Patients will have monthly study visits to download GPS and pedometer data and to fill out questionnaires about history of exacerbations, the last 7 days of PA, and chronic respiratory symptoms. Additionally, patients will be asked to fill out a 7-day activity diary to collect more detailed information about their daily routines. GPS data on patient location throughout the day and place where the MDI was actuated will be linked to data on Seattle air pollution from the Environmental Protection Agency (EPA) and meteorology data from the National Oceanic and Atmospheric Administration (NOAA). Data analysis will focus on descriptive statistics for each measure, characterizing increased short-acting beta agonist use, and measuring patient compliance with the GPS-enabled MDI, pedometer, and activity diary. The results of this study will be used to inform a Merit Review proposal to evaluate the impact of exacerbations on a PA intervention for COPD patients and the contribution of environmental triggers to these exacerbations. Specifically the goals of the future study would be to: 1) determine the factors (including mild exacerbations measured using GPS-enabled MDI use) associated with decreased participation in physical activity, exercise programs, and pulmonary rehabilitation, and 2) to develop an intervention to increase physical activity in COPD that incorporates strategies to prevent exacerbations including avoiding environmental triggers, and maintaining physical activity after experiencing exacerbations. By better understanding the effect of mild exacerbations on PA, as well as the potential environmental triggers of mild exacerbations, we can provide patients and their providers with more appropriate advice about how to reduce exacerbations and develop and sustain PA at home.

描述（由申请人提供）： 高达 20% 的 VA 患者患有慢性阻塞性肺疾病 (COPD)，并且与健康相关的生活质量差、频繁病情恶化和残疾有关。建议 COPD 患者进行体力活动 (PA)，但 PA 可能会受到空气污染和温度变化等环境因素引发的呼吸道症状加重和恶化的影响。短效β受体激动剂支气管扩张剂的使用增加可能反映在急性环境暴露、轻度恶化或中度或重度恶化开始的情况下症状短暂恶化。最近开发的支持全球定位系统 (GPS) 的吸入器可以监控支气管扩张剂使用的位置和时间。使用支持 GPS 的吸入器测量 β 受体激动剂使用量的增加是一种测量轻度恶化的新方法，并且可以更好地了解导致 COPD 恶化和干扰 PA 的环境因素。该研究的具体目标是： 目标 1：使用支持全球定位系统 (GPS) 的短效 β 受体激动剂 (SABA) 吸入器装置捕获不断恶化的呼吸道症状和轻度恶化情况。目标 2：使用计步器和身体活动检查表来表征 COPD 患者的 PA 特征。目标 3：通过支持 GPS 的 SABA 吸入器设备测量，检查环境触发因素（空气污染、温度、相对湿度）是否与轻度恶化有关。拟议的研究将对 40 名患有中度至重度慢性阻塞性肺病的退伍军人进行纵向观察研究。 VA 普吉特湾医疗保健系统诊断患有慢性阻塞性肺病的参与者，如果肺活量测定的 FEV1/FVC 在 0.3 至 0.7 之间，并且正在使用通过计量吸入器 (MDI) 输送的短效支气管扩张剂（例如沙丁胺醇），则将被要求参加。支持 GPS 的监控设备将放置在患者 MDI 罐的顶部，以记录 MDI 使用的时间和位置。参与者将被跟踪总共 12 周。研究确定的数据将包括每日吸入器使用测量（时间、位置）、每日运动（每 30 分钟 GPS 监测一次）以及每日计步器测量的步数。患者将每月进行一次研究访问，下载 GPS 和计步器数据，并填写有关病情加重史、PA 的最后 7 天和慢性呼吸道症状的调查问卷。此外，患者将被要求填写 7 天的活动日记，以收集有关其日常生活的更多详细信息。有关患者全天位置和 MDI 启动地点的 GPS 数据将与美国环境保护局 (EPA) 的西雅图空气污染数据以及美国国家海洋和大气管理局 (NOAA) 的气象数据相关联。数据分析将侧重于每项措施的描述性统计，描述短效β受体激动剂使用增加的特征，并测量患者对支持GPS的MDI、计步器和活动日记的依从性。 这项研究的结果将用于为一项绩效审查提案提供信息，以评估病情加重对 COPD 患者 PA 干预的影响以及环境触发因素对这些病情加重的影响。具体而言，未来研究的目标是：1）确定与体力活动、锻炼计划和肺康复参与减少相关的因素（包括使用支持 GPS 的 MDI 测量的轻度急性加重）；2）制定一种干预措施，增加慢性阻塞性肺病患者的体力活动，其中包括预防急性加重的策略，包括避免环境触发因素，以及在经历急性加重后保持体力活动。 通过更好地了解轻度加重对 PA 的影响，以及轻度加重的潜在环境触发因素，我们可以为患者及其提供者提供关于如何减少加重以及在家中发展和维持 PA 的更合适的建议。