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

慢性阻塞性肺疾病的特征是由有毒颗粒和气体引起的肺损伤和炎症，包括 由香烟烟雾和空气污染产生。不幸的是，目前活跃的吸烟者是最大的 美国的COPD亚群和大多数COPD患者即使吸烟也不能成功戒烟 戒烟是最好的选择。为那些不愿意或还没有的人提供潜在的减少伤害策略 成功戒烟，即没有经过检测，也没有健康风险，就是空气质量的改善。室内 环境尤其令人担忧，因为中到重度COPD患者的大部分时间 在他们的家里。患有慢性阻塞性肺疾病的人，暴露于室内污染物，包括颗粒物 (PM)、二手烟(SHS)和二氧化氮(NO2)的呼吸道发病率更高，包括 病情恶化的风险更高。这些影响不会被他们的吸烟习惯所掩盖。不幸的是，尽管 糟糕的空气质量对呼吸结果的不利影响，无论吸烟状况如何，对我们的 知识，目前还没有针对室内空气质量来改善呼吸的环境干预研究 这不利于吸烟者的健康，从而忽视了减少危害的潜在目标。我们团队在以下方面拥有丰富的专业知识 成功地进行了减少有害室内暴露的试验，包括1)利用 便携式高效空气净化器，特别是空气和碳过滤器，可显著减少室内PM和 NO2浓度，以及2)行为干预，包括动机访谈(MI)以促进健康 改变行为，降低室内空气中尼古丁水平和室内SHS。我们提出了一种随机对照 测试家庭中多种室内污染物(PM、SHS和NO2)是否有针对性地减少的干预试验 对患有慢性阻塞性肺疾病的吸烟者的干预将改善呼吸结果。我们选择了一种强有力的多模式干预 为了最大限度地证明患有慢性阻塞性肺病的活跃吸烟者从 减少室内空气污染。在为期一个月的所有参与者都将接受吸烟的时期之后 戒烟策略包括心肌梗死和尼古丁替代疗法，无法戒烟的参与者 (n=120)将以1：1随机方式接受1)多组分环境干预(活性空气 清洁剂+MI干预以减少SHS)或2)假空气净化器。所有参与者将继续收到 在整个研究期间进行戒烟咨询，包括那些在跑步期间戒烟的人 句号。我们的目标是确定多组分环境干预(针对PM、SHS和 NO2减少)将改善呼吸道发病率(即症状、生活质量、肺功能和病情恶化 风险)(具体目标1)和中间结果衡量标准(即，呼吸道和全身炎症的标志 和氧化应激)(特定目标2)对患有COPD的吸烟者。我们预计这项研究的结果将 告知旨在降低COPD发病率的临床实践指南和医疗保健政策，并可能 对患有慢性病的吸烟者的室内环境建议有更广泛的影响。 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