Efficacy of confronting smokers with airflow limitation for smoking cessation

¹ Dept of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, the Netherlands
² Dept of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
³ Dept of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands

^* To whom correspondence should be addressed. E-mail: d.kotz{at}hag.unimaas.nl;.

	Abstract

The objective of the present study was to test whether confronting smokers with previously undetected COPD increases the rate of smoking cessation.

296 smokers with no prior diagnosis of COPD were detected with mild to moderate airflow limitation by means of spirometry and randomly allocated to; confrontational counselling by a nurse with nortriptyline for smoking cessation (experimental group), regular counselling by a nurse with nortriptyline (control group 1), or "care as usual" for smoking cessation by the general practitioner (control group 2). Only the experimental group was confronted with their abnormal spirometry (mean FEV₁ post-bd.%pred.=80.5, mean FEV₁/FVC post-bd.=62.5).

There was no difference in cotinine validated prolonged abstinence rate between the experimental group (11.2%) and control group 1 (11.6%) from week 5 through 52 (OR=0.96, 95%CI=0.43,2.18). The abstinence rate was about twice as high in the experimental group compared to control group 2 (5.9%), but this difference was not statistically significant (OR=2.02, 95%CI=0.63,6.46).

This study did not provide evidence that the confrontational approach increases the long-term abstinence from smoking rate compared to an equally intensive treatment in which smokers were not confronted with spirometry. The high failure rates (88%) highlight the need for treating tobacco addiction as a chronic relapsing disorder.

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