In response to HL-12-034: Management of HIV-related Lung Disease and Cardiovascular Co-morbidity, we propose to develop methods to improve recognition of chronic obstructive pulmonary disease (COPD) and to mitigate acute exacerbations of COPD (AECOPD) among HIV-infected individuals. Our hypothesis is that earlier identification of acute exacerbations through in-home monitoring of respiratory symptoms, lung function and medication usage will allow appropriate intervention to reduce the morbidity associated with AECOPD. Therefore, we propose using innovative mobile health (mHealth) applications to Respond Early to Acute exacerbations of COPD in HIV (mREACH). mHealth interventions in the HIV-COPD setting hold promise, but prior to embarking on costly clinical trials, methods for improving COPD recognition, for defining the high-risk subset most likely to benefit, and for optimizing the appropriate mHealth technology are needed. COPD remains greatly under-recognized among HIV-infected persons;improving recognition is a requisite first step prior to any intervention. Building on existing data and infrastructure of our on-going HIV-COPD longitudinal studies, we will develop an HIV-specific COPD screening tool to be applied to HIV clinic populations. Evaluating both symptom-based and clinical case definitions, we will characterize risk factors for AECOPD to inform targeting of appropriate participants in future trials. Then, among HIV-infected individuals with spirometry-confirmed COPD, we will conduct a pilot randomized trial of mHealth monitoring compared to usual care to reduce the symptom and clinical burden of AECOPD. Results from this clinical trial planning grant will allow assessment of the feasibility and acceptability of our mHealth applications, guide refinement of the intervention and generate preliminary efficacy data to inform design of future, definitive trials. If effective, the results of this trial will improve the identification, risk statification and management of AECOPD among the high-risk yet underserved HIV-infected population.

Public Health Relevance

This proposal will evaluate the use of mobile health (mHealth) applications to improve prompt identification and management of acute exacerbations of chronic obstructive pulmonary disease (COPD) among persons with HIV. In preparation for future clinical trials, we will develop methods to improve recognition of COPD in HIV clinics, identify HIV-infected persons most at risk for exacerbations, and conduct a pilot study to evaluate the feasibility, acceptability and efficacy of using mHealth monitoring of respiratory symptoms, lung function and medication usage. If effective, this intervention could reduce the morbidity of COPD in the high-risk and underserved HIV-infected population.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Planning Grant (R34)
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Special Emphasis Panel (ZHL1-CSR-H (S1))
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Peavy, Hannah H
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Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
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Lambert, Allison A; Drummond, M Bradley; Kisalu, Annamarie et al. (2016) Implementation of a COPD Screening Questionnaire in an Outpatient HIV Clinic. COPD 13:767-772
Lambert, Allison A; Kirk, Gregory D; Astemborski, Jacquie et al. (2015) HIV Infection Is Associated With Increased Risk for Acute Exacerbation of COPD. J Acquir Immune Defic Syndr 69:68-74
Drummond, M Bradley; Kirk, Gregory D (2014) HIV-associated obstructive lung diseases: insights and implications for the clinician. Lancet Respir Med 2:583-92