Predictors of long-term smoking cessation in patients with COPD: results from a randomised controlled trial

Abstract

In Western countries, cigarette smoking is the most important risk factor for the development of chronic obstructive pulmonary disease (COPD) [1]. Besides, patients with COPD who continue to smoke have a higher prevalence of respiratory symptoms, more accelerated decline in lung function and higher mortality rate than nonsmokers [1]. Therefore, smoking cessation is the single most effective way to prevent COPD and reduce its progression [1]. The Cochrane Review on smoking cessation interventions for people with COPD shows that evidence-based smoking cessation interventions exist, but the chances of successful quitting are still relatively low in this group of smokers [2]. The effectiveness of such interventions can depend on the characteristics of the patient [3]. Knowing which patient characteristics are associated with successful quitting might facilitate the design of more effective smoking cessation interventions for patients with COPD. We used data from a randomised controlled smoking cessation trial to identify patient-specific predictors for long-term abstinence. This trial was originally designed to assess the efficacy of confronting smokers with newly found airflow limitation to facilitate smoking cessation (ISRCTN 64481813) [4]. A total of 296 smokers with mild-to-moderate COPD were randomly allocated to confrontational counselling with a nurse and administered nortriptyline for smoking cessation (experimental group), regular counselling with a nurse and nortriptyline (control group 1), or "care as usual" for smoking cessation by their general practitioner (control group 2) [4, 5]. Inclusion criteria were as follows: a smoking history of ⩾10 pack-years; competency in reading and speaking Dutch; reporting of at least one respiratory symptom (cough, sputum production, or shortness of breath); and a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <70% in combination with post-bronchodilator FEV1 >50% predicted [1, 6]. Exclusion criteria were as follows: having contraindications for the use of nortriptyline; prior respiratory diagnosis; and having undergone spirometry during the preceding 12 months [4, 5].

Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Most Predictive Health Care Factors

“…Patient sociodemographic factors are associated with smoking and cessation in some chronic diseases (10,(12)(13)(14); thus, we hypothesized that patient factors would predict smoking cessation in patients with RA. Instead, we found that health care factors, such as being new to rheumatology care and the health system, were more predictive of smoking cessation.…”

“…In the US, some populations are more likely to be current smokers: men, individuals ages 25-64 years, American Indian/ Alaska Natives, those of low socioeconomic status (SES), and those living in rural areas or in the Midwestern and Southern states (12). Cessation rates in the US are associated with sex, age, race, and SES (10,(12)(13)(14). While smoking cessation is universally recommended, knowing which patient populations are less likely to quit is helpful for targeting interventions.…”

Characteristics of and reasons for patients with chronic obstructive pulmonary disease to continue smoking, quit smoking, and switch to heated tobacco products

“…The number of current smokers was 82 (20.0%), the average duration of smoking was 39.5±12.2 years, and the average number of cigarettes smoked per day was 25.9±13.0. The median CAT score, and mean mMRC score and predicted %FEV 1 were 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 1.4±1.1, and 64.5±23.4%, respectively. The proportion of current smokers in the families of participating patients with COPD was 11%.…”

“…Dis. 2021;19(November):85 https://doi.org/10.18332/tid/142848 2 quit smoking [8][9][10] , few studies have investigated the reasons why these patients quit or not quit smoking.…”

Are we addressing relevant determinants of smoking cessation?

“…The recent prediction analysis by VAN EERD et al [2] based on a series of classic candidate predictors of abstinence, from a randomised controlled trial of chronic obstructive pulmonary disease (COPD) smokers, is no exception. That COPD patients with a high level of education (adjusted OR=3.23), more favourable general health perception (adjusted OR=1.03) and living without a partner (adjusted OR=3.89) were more likely to quit smoking is probably due to a chance finding given the small sample size.…”