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2006 HSR&D National Meeting Abstract


3015 — Spirometry as a Biomotivator to Improve Smoking Cessation Rates: Results from Randomized Trials

Author List:
Wilt TJ (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
Niewoehener D (VA Medical Center, Minneapolis, MN)
Kane RL (University of Minnesota, Minneapolis, MN)
Rutks I (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
Tacklind J (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
MacDonald R (Center for Chronic Disease Outcomes Research, Minneapolis, MN)
Joseph AM (Center for Chronic Disease Outcomes Research, Minneapolis, MN)

Objectives:
Smoking cessation is the most important factor in preventing the development of airflow obstruction and symptomatic chronic obstructive pulmonary disease, and reducing progression of disease. Even relatively small improvements in smoking cessation could have wide spread health benefits. Spirometric testing in primary care settings has been advocated as a motivational tool to improve smoking cessation and maintain abstinence, but its effectiveness is not known. We conducted a systematic review to determine if spirometry testing improves rates of smoking cessation.

Methods:
We searched MEDLINE (1966-July 2005) and the Cochrane Library and consulted experts in the field. Eligible randomized controlled trials enrolled at least 25 smokers per arm, evaluated spirometry alone or in combination with other treatments, followed subjects at least 6 months, and provided smoking abstinence rates. Study patient characteristics and outcomes were extracted by trained abstractors. The primary outcome was biologically validated long-term (> 6 months) sustained abstinence. Additional outcomes included self reported abstinence and point prevalent abstinence.

Results:
Seven RCT (n=6,052 subjects) met eligibility criteria. Follow-up duration ranged from 9-36 months. In 6 trials, the intervention group received concomitant treatments previously demonstrated to independently increase cessation beyond counseling. The range of abstinence was 3-14% for controls and 7-39% among intervention groups, statistically significant in favor of intervention in 4 studies. The only study that assessed the independent contribution of spirometry in combination with counseling demonstrated a non-significant 1% improvement in patient reported point-prevalent abstinence at 12 months (6.5% vs. 5.5%) in the group that received spirometry plus counseling versus counseling alone. Cessation rates were less than in the control group that also received nicotine replacement therapy (7.5%). There were no data regarding cessation rates according to race, gender, spirometric or symptom status.

Implications:
Available evidence is insufficient to determine if spirometry among current smokers improves smoking cessation. However, information from observational studies of spirometry and randomized trials of other biomotivators suggests that any potential effect is likely to be small.

Impacts:
Routine spirometric testing among all current or former smokers has the potential to serve as a biomotivator to improve smoking cessation or maintain abstinence. However, it would require considerable clinical resources to implement and may not be effective. Prior to widespread use of spirometric testing in primary care settings, randomized controlled trials should be conducted to assess its effectiveness for improving smoking cessation.


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