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

慢性阻塞性肺疾病是一种代价高昂的疾病，在急性加重期间，由于医疗保健的利用，其成本负担很大 疾病，特别是那些由急诊室和医院就诊驱动的疾病。此外，很大比例的 最近因急性加重而住院的慢性阻塞性肺疾病患者在一个月内再次住院。 但也是在一年内。这些再次住院给社会带来了巨大的成本负担，不仅是因为 直接成本，但也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 回到家里，回到可能导致他们疾病发病率的环境。室内空气污染 以及与暴露有关的过敏原敏化是家庭环境的重要组成部分 在大部分稳定的前吸烟者门诊人群中表明，这会导致恶化风险 患有慢性阻塞性肺病。然而，人们对最近高度脆弱的个体群体中的这些因素知之甚少。 与稳定期相比，COPD病情恶化住院的患者具有不同的特征和竞争风险 门诊人群。因此，我们建议对COPD患者进行一项单中心观察性研究， 在住院期间因慢性阻塞性肺疾病恶化而招募。我们假设家里的空气污染， 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(特定目标2)将与以下主要结果的高风险相关： 利息，因慢性阻塞性肺疾病加重而再次住院。家庭环境将在一周内进行评估 出院，除临床外，在指数住院后3、6和9个月再次出院 措施。结果将在指数住院后一年内进行评估。这项研究将提供更多 需要关于室内空气污染和接触Re的过敏原致敏作用的信息 最近因病情加重而住院的慢性阻塞性肺疾病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 改善医院出院后的家庭环境，以改善结果，包括重新治疗 慢性阻塞性肺疾病的住院风险。 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