OMEGA COPD Trial SUMMARY Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States, with significantly higher prevalence, morbidity, and mortality in lower income communities. Poor dietary intake, and in particular low omega-3 polyunsaturated fatty acid intake, is a common problem in low-income communities and has been associated with adverse outcomes in populations with respiratory disease. We, and others, have shown that a diet defined by lower omega-3 intake is associated with worse COPD respiratory outcomes. Because omega-3 polyunsaturated fatty acids obtained through diet are responsible for arbitration of pulmonary and systemic inflammation through the eicosanoid pathway, omega-3 intake may also be a critical protector against the adverse effects of pro-inflammatory exposures related to COPD respiratory morbidity. Our group has further demonstrated that indoor air particulate matter (PM) levels are linked to worse respiratory morbidity in individuals with COPD, and indeed a diet low in omega-3 likely augments the adverse effects of pollutant exposure on respiratory morbidity. Unfortunately, low-income individuals with COPD often have diets with omega-3 intake levels well below recommended levels in addition to relatively high levels of indoor PM exposures, leading to heightened risk of poor respiratory outcomes. A dietary intervention, designed to increase intake of omega-3 in food sources, has the potential for high-impact within this vulnerable group. In this proposal, we will test a dietary intervention based in omega-3 rich foods, with the aim of improving respiratory health (Aim 1), and protecting against the adverse effects of environmental exposures (Aim 2) in low income adults with COPD. The intervention will overcome several common nutritional barriers in low-income communities: food insecurity (a voucher will be provided), food access and fresh food availability (home delivery and choice from a range of healthy food options), and support in achieving and sustaining dietary change (regular contact with a dietary health coach trained to support personal behaviors surrounding healthy food choices and provide culturally- informed education around nutrition and food preparation). Through qualitative methods (Aim 3), we will also explore barriers and facilitators of the intervention in order to optimize sustainability of future implementation strategies. Results will comprehensively address the impact of an evidence-based nutrition intervention on COPD health, and provide a framework for dietary intervention within other chronic diseases disproportionately impacting susceptible, low-income populations. Positive results will be buoyed by existing infrastructure within a leading national grocery delivery service supportive of expanding access to healthy foods, providing a ready platform for sustainability and dissemination beyond the study and with immediate policy implications.