The effect of motivational lung age feedback on short-term quit rates in smokers seeking intensive group treatment: A randomized controlled pilot study

Abstract

Background: A brief "Lung Age" feedback intervention has shown promise for personalizing the health impact of smoking and promoting cessation in unselected smokers. Now that many healthcare organizations provide face-to-face cessation services, it is reasonable to ask whether such motivational feedback of lung function tests might improve treatment compliance and cessation rates in smokers wanting to quit. This study assessed effects of baseline motivational spirometry-based "Lung Age" feedback on treatment compliance and tobacco abstinence at 28-day follow-up.

Methods: This randomized controlled pilot study took place in Penn State University-affiliated outpatient medical practices. Participants were 225 adult smokers (≥5 cigarettes/day) willing to attend tobacco dependence treatment. At assessment lung function (FEV-1) and exhaled carbon-monoxide (CO) were assessed. The Intervention group (n=120) were randomly allocated to receive motivational "Lung Age" feedback estimated by FEV-1 and on exhaled CO; Control group (n=105) received minimal feedback. Participants were offered 6 weekly group smoking cessation sessions and nicotine patches and followed-up 28 days after target quit date. The primary outcome measure was self-reported 7-day tobacco abstinence, confirmed by CO<10ppm at 28-day follow-up.

Results: Quit rates were similar at follow-up (Intervention 50.8%; Control 52.4%; p=0.65) after controlling for abstinence predictors. Group attendance and patch use were similar. Among those attending follow-up (n=164, 73%), a greater proportion of the Intervention group had improved lung function (67% vs. 46%; p=0.0083).

Conclusions: Baseline Lung Age feedback did not improve quit rates or compliance at 28-day follow-up in smokers seeking intensive treatment.

Trial registration: ClinicalTrials.gov NCT01980485.

Keywords: Carbon-monoxide; Cessation; Dependence; FEV-1; Smoking; Spirometry; This study was registered at ClinicalTrials.gov (identifier: NCT01980485).

Conflict of interest statement

CONFLICT OF INTEREST. JF has done paid consulting for pharmaceutical companies involved in producing smoking cessation medications, including GSK, Pfizer, Novartis, J&J, and Cypress Bioscience.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

CONSORT diagram for the study. 373 individuals were assessed for eligibility using a phone screen. Of these 373 individuals, 16 were not interested in participating in the study; 2 did not consent to continue with the phone screen; 40 were found to be ineligible after phone screening; 13 yielded duplicate or incomplete phone screens; 11 did not schedule an assessment visit appointment; 64 did not attend their scheduled assessment visit; and 2 did not consent to participating in the study at their assessment visit. The remaining 225 participants underwent randomization to either the Intervention (n=120) or Control group (n=105). Of these groups, 36 and 25 participants did not attend the 28-day follow-up visit, respectively. All 225 were included in the intent-to-treat analysis.

Figure 2

Graphic used to provide “Lung Age” feedback used in the study. Adapted from Fletcher, BMJ 1977; Kohansal, Am J Resp Crit Care Med 2009; and Scanlon, Am J Resp Crit Care Med 2000.

Figure 3

Summary of study outcomes. Figure 3 depicts the following measures in the Intervention and Control groups: (a) percent attendance at each group meeting (out of a total of n=120 participants in the Intervention group and n=105 in the Control group; raw number of attending participants given above each bar); (b) percent using the transdermal nicotine patches in the previous week at each visit (as a percentage of the number of participants attending each group meeting; see (a)); (c) mean exhaled CO among those attending at each visit (see (a) for raw number of participants attending each group meeting); and (d) intent-to-treat percent attending with a CO