MedWire News: Confronting smokers with spirometry data showing previously undetected chronic obstructive pulmonary disease (COPD) does not increase the long-term abstinence from smoking rate compared with an equally intensive treatment program in which smokers are not confronted with spirometry, researchers report.
“Confrontational counseling may have short-term effects, but these diminish during the first year after initial counseling treatment,” report Daniel Kotz (Maastricht University Medical Center, The Netherlands) and colleagues in the European Respiratory Journal.
Discussing abnormal spirometry test results with smokers has been suggested as a "teachable moment" that may increase motivation to quit smoking, the authors note, but there is only weak evidence to support such an approach.
However, the most recent randomized trial, reported by MedWire News, clearly showed a positive effect; telling smokers their "lung age" (based on spirometry) increased the abstinence rate by 7.2% after 52 weeks.
Kotz and team proposed that early detection of COPD and confrontation with spirometry may be effective for smoking cessation if "confrontational counseling" was applied, in which smokers are confronted with the consequences of their addiction (previously undiagnosed COPD) and which uses specific communication skills to identify and challenge irrational beliefs about smoking.
A total of 296 smokers with no prior diagnosis of COPD who had mild-to-moderate airflow limitation determined by spirometry were randomly assigned to receive either confrontational counseling by a nurse with nortriptyline for smoking cessation (experimental group), regular counseling by a nurse with nortriptyline (control group 1), or "care as usual" for smoking cessation by the family physician (control group 2). Only the experimental group was confronted with their abnormal spirometry results.
The researchers found no difference in cotinine validated prolonged abstinence rate between the experimental group (11.2%) and control group 1 (11.6%) from week 5 through to week 52. By contrast, the abstinence rate was about twice as high in the experimental group compared with control group 2 (5.9%), but this difference was not statistically significant.
“The high failure rates dramatically emphasize the difficulty tobacco-addicted smokers experience with quitting smoking and highlight the need for treating tobacco addiction as a chronic relapsing disorder and to match it with an appropriate and tailored amount of care,” the authors write.
They conclude: “This is especially indicated in smokers with respiratory disease, who have a more urgent need to stop smoking. Future research should investigate whether repeated counseling sessions during a longer follow-up period can consolidate an initial short-term effect and therefore increase long-term smoking cessation rates.
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Smokers more likely to quit if told their lung age