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

COPD的特征在于由有害颗粒和气体引起的肺损伤和炎症， 从香烟烟雾和空气污染中散发出来。不幸的是，目前活跃的吸烟者代表了最大的 美国的COPD患者和大多数COPD患者即使吸烟也无法成功戒烟 停止是最好的选择。一个潜在的减少伤害的策略，对于那些谁不会或还没有 成功戒烟，未经测试，没有健康风险，是改善空气质量。室内 环境是特别值得关注的，因为中度至重度COPD患者大部分时间 在他们的家里。COPD患者暴露于室内污染物（包括颗粒物）的程度较高 (PM)、二手烟（SHS）和二氧化氮（NO2）的呼吸系统发病率更高， 加重的风险更高。这些影响并没有被他们的吸烟习惯所掩盖。不幸的是，尽管 空气质量差对呼吸结果的明显有害影响，无论吸烟状况如何， 知识，没有研究针对室内空气质量的环境干预措施，以改善呼吸道 吸烟者的健康，从而忽视了减少危害的潜在目标。我们的团队拥有丰富的专业知识， 开展成功减少有害室内暴露的试验，包括1）利用 便携式空气净化器，具有高效的特殊空气和碳过滤器，可显著减少室内PM， NO2浓度，和2）行为干预，包括动机访谈（MI），以促进健康 行为改变和减少家庭空气中的尼古丁水平和室内SHS。我们提出了一个随机对照 干预试验，以测试是否有针对性地减少多种室内污染物（PM，SHS和NO2）在家中 吸烟的COPD患者将改善呼吸结果。我们选择了一种有效的多模式干预， 为了最大限度地证明积极吸烟者的健康益处， 减少室内空气污染。经过一个月的磨合期，所有参与者都将接受吸烟 戒烟策略，包括MI和尼古丁替代疗法，参与者无法戒烟 （n=120）将按照1：1的比例随机接受1）多组分环境干预（活性空气） 清洁器+ MI干预以减少SHS）或2）假空气清洁器。所有参与者将继续获得 整个研究期间的戒烟咨询，包括那些在导入期戒烟的人 期我们的目标是确定多组分环境干预（针对PM，SHS和 NO2减少）将改善呼吸系统发病率（即，症状、生活质量、肺功能和加重 风险）（具体目标#1）和中间结果测量（即，气道和全身炎症标志物 和氧化应激）（具体目标#2）。我们预计，这项研究的结果将 旨在降低COPD发病率的临床实践指南和医疗保健政策， 对慢性病吸烟者室内环境建议的更广泛影响。 1

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