Telling smokers their “lung age” promoted successful smoking cessation
Dr G Parkes, The Limes Surgery, Hoddesdon, Hertfordshire, UK;
Does describing to patients how smoking has accelerated their age-related decline in lung function (“lung age”) increase smoking cessation rates?
randomised controlled trial.
blinded (outcome assessors).
5 general practices in Hertfordshire, UK.
561 current smokers ⩾35 years of age (mean age 53 y, 54% women, mean 17 cigarettes/d, mean 33 pack-y of smoking). Patients receiving oxygen or with a history of lung cancer, tuberculosis, asbestosis, silicosis, bronchiectasis, or pneumonectomy were excluded.
all patients had spirometry at baseline to measure forced expiratory volume at 1 second (FEV1). Patients in the intervention group (n = 280) were immediately given their results verbally and graphically as “lung age” (the age of the average healthy person who has an FEV1 equal to that of the patient); patients in the control group (n = 281) were not told their results at this time. Within 4 weeks, all patients received a personalised letter from the study doctor, giving test results (as lung age for the intervention group and as FEV1 with no explanation for the control group), a strong statement about the importance of smoking cessation regardless of the test results, and contact details for smoking cessation services.
smoking cessation (verified by saliva cotinine test) and daily cigarette consumption.
89% (intention-to-treat analysis).
At baseline, 27% of the intervention group and 23% of the control group had abnormal FEV1 (<80% of predicted). In the intervention group, mean lung age deficit (lung age minus actual age) was 9.3 years. Telling patients their lung age increased verified smoking cessation rate and reduced daily cigarette consumption at 12 months (table).
Telling smokers their lung age after spirometry increased the likelihood of successful smoking cessation 1 year later.
A modified version of this abstract appears in ACP Journal Club.
Parkes G, Greenhalgh T, Griffin M, et al. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008;336:598–600.
Clinical impact ratings: Family/general practice 5/7; Health promotion 5/7; Public/community health 6/7
The benefits of smoking cessation are well documented, but cessation programmes with high quit rates remain elusive. Several types of non-pharmacologic interventions, including self-help programmes, telephone counselling, group counselling, behavioural therapy, and health provider–directed programmes, have shown small treatment effects. A Cochrane review examined biomedical risk assessment as a motivational strategy for smoking cessation, including only 1 eligible trial of spirometry that showed no treatment effect.1
The randomised trial by Parkes et al used a 3-part intervention. Study results support the argument that concrete, visual feedback helps motivate smokers to quit. Although a 14% quit rate at 12 months is good for this type of intervention, an 86% failure rate indicates that more research is needed. The authors suggested a line of research when they grouped smokers into 4 stages of change based on a modification of Prochaska and DiClemente’s transtheoretical model.2 The current study was not designed to test the effectiveness of the intervention in relation to smoker’s stage of change (precontemplative, contemplative, preparation, or action), but such an approach may be an important next step.
A visual, personalised representation of lung-age data, provided to patients in the context of information about lung status and the effect of smoking, makes sense. However, not all spirometry equipment provides this information. Fortunately, readers interested in using this approach can get a lung-age calculator from the study authors along with more details at www.step2quit.co.uk. Nurses considering this intervention or another approach might examine a recent Cochrane review of nursing interventions for smoking cessation.3