The Home Environment and Re-hospitalization in COPD study (HEAR COPD)

COPD是一种昂贵的疾病，急性加重期间的医疗保健利用导致了巨大的成本负担 疾病，特别是那些由急诊室和医院就诊驱动的疾病。此外，大部分 最近因急性加重住院的COPD患者在一个月内再次住院， 而且是在一年之内。这些再住院给社会带来了巨大的成本负担，这不仅是因为 直接成本以及间接成本和生产力损失。大多数COPD患者出院后 回到家，回到可能导致他们疾病发病的环境。室内空气污染 和过敏原致敏是家庭环境的重要组成部分， 如在大多数稳定的既往吸烟者门诊人群中所示， COPD。然而，最近对高度脆弱的个体群体中的这些因素知之甚少 COPD急性加重住院患者的特征和竞争风险与稳定 门诊人群。因此，我们建议对COPD患者进行单中心观察性研究， 在COPD急性加重住院期间招募。我们假设室内空气污染， 包括超细和细颗粒物和二氧化氮（具体目标1）以及过敏原 暴露致敏（具体目标2）将与以下主要结局的风险升高相关： 关注，因COPD加重而再次住院。家庭环境将在一周内进行评估， 出院，并在首次住院后3、6和9个月再次进行临床试验， 措施将在首次住院后长达一年的时间内评估结局。这项研究将提供很多 需要了解室内空气污染和过敏原致敏与暴露于再 近期因急性加重住院的COPD患者高危人群的住院情况。我们 我相信这项研究可以提供有价值的信息，最终可以用来设计干预措施 改善出院后的家庭环境，目的是改善结局，包括重新 COPD的住院风险。 1

COPD is a costly disease with a large burden of costs driven by healthcare utilization during acute exacerbations of illness, particularly those driven by emergency room and hospital visits. Additionally, a large proportion of individuals with COPD recently hospitalized for acute exacerbations are re-hospitalized both within one month but also within a year. These re-hospitalizations place a tremendous burden of cost on society not just due to direct costs but also indirect costs and lost productivity. A majority of individuals with COPD are discharged home, back to the very environment that was likely contributing to their disease morbidity. Indoor air pollution and allergen sensitization with exposure are important components of the home environment that likely contribute to exacerbation risk as has been shown in mostly stable, outpatient populations of former smokers with COPD. However, little is known about these factors in the highly vulnerable population of individuals recently hospitalized with COPD exacerbations, who have different characteristics and competing risks than stable outpatient populations. Accordingly, we propose a single center observational study of individuals with COPD, to be recruited during hospitalization for COPD exacerbation. We hypothesize that in-home air pollution, including ultrafine and fine particulate matter and nitrogen dioxide (Specific Aim 1) as well as allergen sensitization with exposure (Specific Aim 2) will be associated with heightened risk for the primary outcome of interest, re-hospitalization for COPD exacerbation. The home environment will be assessed within 1 week of discharge from the hospital, and again at 3, 6, and 9 months post index hospitalization in addition to clinical measures. Outcomes will be assessed up to one year post index hospitalization. This study will provide much needed information about the contribution of indoor air pollution and allergen sensitization with exposure to re- hospitalizations in the high-risk population of individuals with COPD recently hospitalized for exacerbation. We believe that this study can provide valuable information which can ultimately be utilized to design interventions to modify the home environment post-hospital discharge with the goal to improve outcomes including re- hospitalization risk in COPD. 1