Preventing hospitalizations for COPD exacerbations due to air pollution from wildfire smoke

PROJECT SUMMARY This K23 will provide Laura Myers MD, MPH with time and resources to pursue additional training to become an independent investigator and leader in mitigating environmental harms in diverse patients with chronic obstructive pulmonary disease (COPD). Dr. Myers is a Harvard-trained, board certified pulmonary/critical care physician and Assistant Professor-level researcher at the Kaiser Permanente Northern California Division of Research. COPD exacerbations are associated with worse mortality and quality of life and account for 65% of COPD-related health care costs ($18B/year). There is an urgent need to identify patients at high-risk of hospitalization for COPD exacerbations and find effective interventions. Up to 30% of COPD exacerbations are due to particulate matter air pollution (PM2.5, where ≤2.5µm refers to particle diameter). A growing fraction (>20%) of PM2.5 comes from wildfires, which is considered more toxic than PM2.5 from other sources. PM2.5 disproportionately enters the homes of people with low socioeconomic status (SES) through poor sealing/ventilation systems. An expert panel has identified a critical knowledge gap, lack of evidence on effectiveness of interventions, such as indoor portable air cleaners, in the wildfire setting. In this proposal, Dr. Myers will complete the following aims: 1) develop and externally validate a prediction model that incorporates geocoded air pollution and wildfire smoke data to identify patients at highest risk of hospitalization for COPD exacerbation, 2) identify modifiable barriers to and facilitators of interventions that mitigate exposure to air pollution from wildfires in COPD patients with low SES, and 3) conduct a 2-arm, randomized controlled pilot of a multimodal intervention to mitigate exposure to air pollution from wildfires in high-risk COPD patients with low SES. Dr. Myers proposes 4 training aims to gain: 1) advanced training in prediction modeling methods using geocoded air pollution variables as predictors, 2) training in qualitative methods, 3) methodologic expertise in designing and executing a clinical trial, and 4) deeper understanding of the social determinants of health and health equity. This research is significant because reducing hospitalizations for COPD exacerbations due to air pollution from wildfire smoke would improve patients’ quality of life, long-term clinical outcomes and healthcare costs. This research is innovative because a scalable, non-pharmacologic, evidence-informed intervention (air cleaners) is applied to a new setting (wildfires) as part of a multimodal intervention, using an ideal testbed (planned burns within a large catchment area). The work will provide preliminary data for an R01 to test a multimodal intervention in high-risk patients with COPD and low SES during active wildfires. The results of future work could lead to policy changes, as demonstrating effectiveness of an intervention could make the equipment more accessible to patients. The proposal builds on Dr. Myers’ clinical background as a pulmonologist and previous MPH work. It leverages access to unparalleled longitudinal data for >4.5 million patients, a world-class mentoring team and advanced analytic training at UC San Francisco and Berkeley.