Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study

Abstract

ObjectiveThis 12-month study in a primary healthcare network aimed to assess the effectiveness of usual smoking cessation advice compared with personalised information about the spirometry results.DesignRandomised, parallel, controlled, multicentre clinical trial.SettingThis study involved 12 primary healthcare centres (Tarragona, Spain).ParticipantsActive smokers aged 35–70 years, without known respiratory disease. Each participant received brief smoking cessation advice along with a spirometry assessment. Participants with normal results were randomised to the intervention group (IG), including detailed spirometry information at baseline and 6-month follow-up or control group (CG), which was simply informed that their spirometry values were within normal parameters.Main outcomeProlonged abstinence (12 months) validated by expired-CO testing.ResultsSpirometry was normal in 571 patients in 571 patients (45.9% male), 286 allocated to IG and 285 to CG. Baseline characteristics were comparable between the groups. Mean age was 49.8 (SD ±7.78) years and mean cumulative smoking exposure was 29.2 (±18.7) pack-years. Prolonged abstinence was 5.6% (16/286) in the IG, compared with 2.1% (6/285) in the CG (p=0.03); the cumulative abstinence curve was favourable in the IG (HR 1.98; 95% CI 1.29 to 3.04).ConclusionsIn active smokers without known respiratory disease, brief advice plus detailed spirometry information doubled prolonged abstinence rates, compared with brief advice alone, in 12-month follow-up, suggesting a more effective intervention to achieve smoking cessation in primary healthcare.Trial registration numberNCT01194596.

Spirometry and Smoking Cessation in Primary Care: The ESPIROTAB STUDY, A Randomized Clinical Trial

“…When comparing our study with the existing literature, we see that the findings are diverse [ 7 , 27 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Few studies have assessed the effect of feedback on spirometry results [ 36 , 37 , 38 ] or lung age [ 39 , 40 , 41 , 42 , 43 ] independently, and they offer opposing results.…”

“…When comparing our study with the existing literature, we see that the findings are diverse [ 7 , 27 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Few studies have assessed the effect of feedback on spirometry results [ 36 , 37 , 38 ] or lung age [ 39 , 40 , 41 , 42 , 43 ] independently, and they offer opposing results. The dropout rates of previous studies range from 2 to 24% in the control group and 6.5 to 32% in the intervention group, with a higher dropout rate in the IG, although it is not statistically significant [ 37 , 38 , 39 , 41 ].…”

“…Only three studies found statistically significant differences [ 36 , 40 , 42 ], two of them regarding feedback on lung age results [ 40 , 42 ].…”

Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

“…The introduction of a smoking cessation discussion at appropriate points during the screening pathway (e.g., initial appointment; LDCT results provision; investigation of suspicious or incidental findings) could increase participation or reaffirm reasons for stopping in people who have recently quit. Indeed, research has shown that abnormal spirometry results, 28 , 41 abnormal screening results including the need for further tests 18 , 19 , 28 or a lung cancer diagnosis 42 may lead to increased motivation and the likelihood of cessation. Additionally, the time between registering for lung cancer screening and receipt of results is associated with increased ‘readiness to quit’, particularly among individuals attending their first screening.…”

“…In addition to receipt of personalized lung health information as a gateway to an initial discussion, participants felt that cessation discussions and interventions should be tailored further. Participants often stated that there is no 'one size fits all' cessation method with many varied opinions Indeed, research has shown that abnormal spirometry results, 28,41 abnormal screening results including the need for further tests 18,19,28 or a lung cancer diagnosis 42 may lead to increased motivation and the likelihood of cessation. Additionally, the time between registering for lung cancer screening and receipt of results is associated with increased 'readiness to quit', particularly among individuals attending their first screening.…”