Ethical analysis of the justifiability of labelling with COPD for smoking cessation

Kotz, Daniel; Vos, Reinder; Huibers, Marcus J.H.

doi:10.1136/jme.2009.029280

Cited by 11 publications

(6 citation statements)

References 41 publications

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“…In a study focusing on this issue [29], 86% of smokers agreed with lung function being measured since this could increase awareness of the negative effects of smoking and increase motivation to give up smoking.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study

Irizar-Aramburu¹,

Martínez-Eizaguirre²,

Pacheco-Bravo³

et al. 2013

BMC Fam Pract

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BackgroundSmoking is the main preventable cause of morbidity and mortality in our region, it being the main causative agent of chronic obstructive pulmonary disease. There still is no consensus on the use of spirometry as a strategy for smoking cessation, given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique.Methods/DesignThis is to be a randomized, multicentre, open-label clinical trial. A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers. Primary objective of this study is to assess the effectiveness of spirometry together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease. Groups of 45 patients who smoke will be randomly selected from the lists of the participating doctors. The names will be sent to the corresponding doctors who will contact candidate patients and assess whether they meet the selection criteria. Patients who meet these criteria will be randomly allocated to an intervention or control group. For patients in both groups, a nurse will conduct an interview and perform a spirometry test to measure forced vital capacity. Then, all patients will be referred for an appointment with their doctor for brief anti-smoking intervention, patients from the intervention group additionally being informed about the result of the spirometry test. After 1 year, smoking status will be assessed and, in those who report that they have quit smoking, abstinence will be confirmed by co-oximetry. Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables.DiscussionPerforming a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among smokers who are asymptomatic or have few symptoms and make them decide to quit. Specifically, in patients with chronic obstructive pulmonary disease it might increase levels of motivation to quit smoking in early stages of the disease. If this strategy were to be effective, it could be included in the health promotion activities offered in primary care.Trial registrationClinicalTrials.gov Identifier: NCT01821885

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Section: Discussionmentioning

confidence: 99%

Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study

Irizar-Aramburu¹,

Martínez-Eizaguirre²,

Pacheco-Bravo³

et al. 2013

BMC Fam Pract

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“…Interestingly, 86% agreed that performing spirometry on heavy smokers is a good idea to raise awareness of the negative effects of smoking and that it might help prevent further disease and decrease smoking rates. 15% felt that it interfered with their freedom of choice [45].…”

Section: What Do Patients Think?mentioning

confidence: 99%

Screening for COPD: the gap between logic and evidence

Kaplan

Thomas

2017

Eur Respir Rev

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Chronic obstructive pulmonary disease (COPD) is a common disease leading to further morbidity and significant mortality. The first step for any condition is to make the appropriate diagnosis, and spirometry barriers abound in practice around the world. It is tempting to undertake mass screening on all smokers to detect COPD. While this would pick up cases of COPD, results of studies of its effect on COPD end-points such as exacerbations, hospitalisations and mortality are disappointing. As such, aggressive case finding of COPD by screening for symptoms that patients may not themselves perceive is very important in primary care, with subsequent spirometry defining the diagnosis.We also have to separate out population screening from individual patient interactions. Performing spirometry, even on a truly asymptomatic patient, may allow earlier diagnosis and modification of risk factors such as smoking (mostly) and exacerbation risk. It also recognises patients with early disease who are at high risk of comorbidities such as cardiac illness, such that appropriate treatment strategies can be implemented. Making a diagnosis, and even the fact of worrying about such a diagnosis, can affect the motivational level of the individual patient to cease smoking; all patients should of course be counselled to stop smoking. As such, consider the individual patient in front of you for unrecognised symptoms and therefore unrecognised illness, as making a diagnosis earlier can allow the institution of care, including smoking cessation, vaccination, bronchodilators and comorbidity management.

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“…Programmes involving the detection of new COPD cases could lead to higher smoking cessation rates (14). Similarly, a qualitative study reported that the majority of smokers agreed that measuring and confronting them with their lung function was justifiable in helping with attempts to quit (15, 33).…”

Section: Discussionmentioning

confidence: 99%

Assessing Airflow Limitation among Smokers in a Primary Care Setting

Yau

Rahim

Sheng

et al. 2018

MJMS

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BackgroundMany smokers have undiagnosed chronic obstructive pulmonary disease (COPD), and yet screening for COPD is not recommended. Smokers who know that they have airflow limitation are more likely to quit smoking. This study aims to identify the prevalence and predictors of airflow limitation among smokers in primary care.MethodsCurrent smokers ≥ 40 years old who were asymptomatic clinic attendees in a primary care setting were recruited consecutively for two months. We used a two-step strategy. Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using a pocket spirometer. Multiple logistic regression was utilised to determine the best risk predictors for airflow limitation.ResultsThree hundred participants were recruited. Mean age was 58.35 (SD 10.30) years old and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found to have airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year history and Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness of COPD were low.ConclusionsThe high prevalence of airflow limitation and low readiness to quit smoking imply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additional motivator for smoking cessation intervention may be considered. A two-step case-finding method is potentially feasible.

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Ethical analysis of the justifiability of labelling with COPD for smoking cessation

Abstract: Labelling with disease is probably a less important issue in the discussion about the pros and cons of early detection of COPD.

Cited by 11 publications

References 41 publications

Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study

Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study

Screening for COPD: the gap between logic and evidence

Assessing Airflow Limitation among Smokers in a Primary Care Setting

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