Crystal M. North, MD

Air pollution is the leading cause of COPD globally. By 2050, the global COPD burden will be concentrated in sub-Saharan Africa, where air pollution is among the worst in the world. The 2023 GOLD Scientific Committee emphasized an urgent need for targeted mitigation strategies to prevent air pollution exposure. Although the World Health Organization recently established air pollution exposure mitigation guidelines, they are unlikely to be applicable to populations at risk for COPD in sub-Saharan Africa. There are therefore no evidence-based guidelines ready for
implementation in the community at greatest risk of air pollution-associated COPD. In this proposal, we will 1) develop a conceptual framework to explain facilitators and barriers of behaviors to reduce personal air pollution exposure using formalized theories of behavioral change and 2) design and pilot test a contextually appropriate educational strategy to reduce personal air pollution exposure among people at risk for COPD in Uganda. The feasibility of this work is supported by our interdisciplinary team of expertise in air pollution, pulmonology, and behavioral science and qualitative methodology. By leveraging the established research infrastructure of two active observational cohort studies of adults and adolescents in Uganda (CAD-Lung and TIMING), we will explore knowledge and beliefs around air pollution exposure and promotion of optimal lung health through focus group discussions [Aim 1]. We will then use Aim 1 results to design and pilot test a multifaceted strategy (the CLEARCOPD Toolkit) to promote behavior change to reduce personal air pollution exposure [Aim 2]. Findings from this study will provide the requisite preliminary data for a hybrid implementation-effectiveness randomized controlled trial in which we will evaluate the impact, implementation, and cost effectiveness of the CLEAR-COPD Toolkit. Our overarching goal is to develop an evidence base for novel air pollution reduction interventions to reduce COPD risk in under-represented communities.

Funded by the ALA/Chest Guideline Implementation Research Grant for Chronic Obstructive Pulmonary Disease