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

慢性阻塞性肺病研究中的家庭环境和再住院 (HEAR COPD)

基本信息

批准号：
10017972
负责人：
Nirupama Putcha
金额：
$ 63.89万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10017972
关键词：
Accident and Emergency department Acute Air Air Pollution Allergens Allergic Asthma Automobile Driving Back Bacterial Infections Baltimore Biometry Cause of Death Characteristics Chronic Obstructive Airway Disease Clinical Clinical Research Cohort Studies Collaborations Collection Complex Cost of Illness Data Data Analytics Direct Costs Disease Dust Emergency department visit Environment Environmental Health Epidemiology Exposure to Facilities and Administrative Costs Future Goals Health Health Expenditures Home environment Hospitalization Hospitals Hypersensitivity Immunology Individual Indoor Air Pollution Indoor environment Infrastructure Lung Lung diseases Measures Mentored Patient-Oriented Research Career Development Award Methods Modification Morbidity - disease rate Nitrogen Dioxide Observational Study Outcome Outpatients Particulate Matter Patients Population Prevalence Productivity Research Research Infrastructure Research Personnel Risk Risk Factors Smoker Societies Testing Ultrafine United States Virus Diseases Visit Vulnerable Populations Work adverse outcome base clinical phenotype coarse particles cohort cost data management economic cost environmental intervention environmental tobacco smoke experience fine particles health care service utilization high risk high risk population hospital readmission improved outcome indexing indoor allergen indoor pollutant interest modifiable risk multimodality pollutant primary outcome recruit societal costs therapy design ultrafine particle

项目摘要

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

慢性阻塞性肺病是一种代价高昂的疾病，在急性发作期间医疗保健的利用造成了巨大的成本负担疾病，特别是那些因急诊和医院就诊而导致的疾病。此外，很大一部分最近因急性加重住院的慢性阻塞性肺病患者在一个月内再次住院而且也在一年之内。这些再住院给社会带来了巨大的成本负担，不仅仅是因为直接成本，还有间接成本和生产力损失。大多数慢性阻塞性肺病患者已出院回到家，回到可能导致疾病发病的环境。室内空气污染暴露引起的过敏原致敏是家庭环境的重要组成部分，正如大多数稳定的戒烟者门诊人群所显示的那样，会导致病情恶化的风险患有慢性阻塞性肺病。然而，最近人们对高度脆弱人群中的这些因素知之甚少因慢性阻塞性肺病（COPD）恶化而住院，与稳定状态相比，他们具有不同的特征和竞争风险门诊人群。因此，我们建议对慢性阻塞性肺病患者进行单中心观察研究，因 COPD 恶化住院期间招募。我们假设家庭空气污染，包括超细颗粒物和细颗粒物、二氧化氮（具体目标 1）以及过敏原暴露致敏（具体目标 2）将与主要结局的风险增加相关兴趣，因 COPD 恶化而再次住院。家庭环境将在 1 周内进行评估出院，并在指数住院后第 3、6 和 9 个月再次进行临床检查措施。将在指数住院后一年内评估结果。这项研究将提供很多需要有关室内空气污染和过敏原致敏与暴露于再接触的影响的信息最近因病情加重而住院的慢性阻塞性肺病患者的高危人群的住院情况。我们相信这项研究可以提供有价值的信息，最终可用于设计干预措施改变出院后的家庭环境，以改善结果，包括重新 COPD 的住院风险。 1