Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking

Abstract

BackgroundThis study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention.MethodA multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention.ResultsThe study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group.ConclusionIn this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.

Time trends in access to smoking cessation support for people with depression or severe mental illness: a cohort study in English primary care

“… 44 There is some evidence that better quit rates can be achieved when smoking cessation is integrated within specialist mental healthcare settings 45 or with the addition of spirometry and feedback on lung age and degree of airways obstruction. 46 Our findings suggest that in order to close the widening gap in smoking prevalence and its consequences for people with mental health conditions, the focus in primary care should change from the quantity of advice given to the quality. This should include routine assessment of willingness to change, greater provision of assistance to quit and arranging follow-up as part of a ‘5As’ strategy 31 and could include other elements such as spirometry with feedback to better support smoking cessation in people with mental health conditions.…”

“…This is of concern given the ongoing high smoking rates in those with poor mental health, particularly those with SMI 44. There is some evidence that better quit rates can be achieved when smoking cessation is integrated within specialist mental healthcare settings45 or with the addition of spirometry and feedback on lung age and degree of airways obstruction 46. Our findings suggest that in order to close the widening gap in smoking prevalence and its consequences for people with mental health conditions, the focus in primary care should change from the quantity of advice given to the quality.…”

Inflammatory Response in SARS-CoV-2 Infection of Patients with Schizophrenia and Long-Term Antipsychotic Treatment

“…Pulmonary and metabolic comorbidities were significantly increased in the group of patients with schizophrenia, they being more prone to associate pulmonary, metabolic, cardiovascular comorbidities. 21,22 They smoke excessively, 23 have a sedentary lifestyle 24 with an unbalanced diet 25 which predisposes them to severe cardiac events and sudden death. 26 The fact that patients were already hospitalized and their comorbidities were monitored, treated and stable, the fact that they live in a controlled environment with a caloric diet and also with smoking restrictions, can all be considered factors that have contributed to a low level of mortality and to full recovery after SARS-CoV-2 infection.…”

How to Enhance the Diagnosis of Early Stages of Chronic Obstructive Pulmonary Disease (COPD)? The Role of Mobile Spirometry in COPD Screening and Diagnosis—A Systematic Review

“…Eleven studies using portable spirometers in the COPD-targeted -screening process met the predefined criteria (Group A, Table 1) [25][26][27][28][29][30][31][32][33][34][35]. In all selected articles, a portable spirometer was used both for the baseline spirometry and in the postbronchodilator testing.…”