Intervention for Smokers With COPD, Asthma Boosts Quit Rates

Immediately linking chronic obstructive pulmonary disease (COPD) and asthma patients who smoke to an appointment at a smoking cessation clinic significantly improved quit rates, a multicenter trial from Turkey showed.

Among nearly 400 smokers recruited from respiratory clinics, self-reported quit rates at 3 months reached 27% for those randomized to an immediate appointment at an outpatient smoking cessation clinic, as compared with 17% with usual care, which involved referral to a smoking quitline (P=0.014), reported Dilek Karadogan, MD, of Recep Tayyip Erdoğan University in Rize, Turkey.

“Smoking cessation aid should be part of routine care in patients with chronic airway diseases,” she said at the annual European Respiratory Society (ERS) congress in Vienna. “Our study revealed a five-fold increase in quit rates with evidence-based smoking cessation assistance, and the rate of access to this help was higher in the immediate-appointment group than in the usual-care group.”

At 3 months, significantly more patients in the immediate-appointment arm had visited a smoking cessation clinic (75% vs 27%) and received evidence-based medication to help them quit smoking (69% vs 22%; P<0.001 for both).

In her introduction, Karadogan noted that a significant proportion of patients with chronic lung diseases continue to smoke tobacco even after being diagnosed with their condition. In the U.S., 38% of COPD patients and 21% of asthma patients are current smokers, according to 2013 data from the CDC.

Furthermore, said Karadogan, information is limited on the impact of standard brief tobacco cessation interventions — such as the “5A” method (ask, advise, assess, assist, arrange) — for smokers with COPD or asthma.

“We know that 60-70% of smokers have the desire to quit smoking, but only 3-5% of self-quitters achieve a prolonged abstinence,” said ERS-designated discussant Armin Frille, MD, of Leipzig University in Germany.

The current results, he noted, mirror findings from the Quit Smoking Lung Health Intervention Trial of patients undergoing lung cancer screening. In that study, 3-month self-reported quit rates reached 21% for those who received immediate telephone smoking cessation support and pharmacotherapy versus 9% with usual care — advice to quit and information on smoking cessation services.

Frille noted that the main limitation of the current study was that tobacco cessation wasn’t biochemically verified. And when he asked whether the quit rates were sustained at longer follow-up, Karadogan reported that the differences at 1 year remained significant, at 19% in the study arm and 12% in the control arm.

From November 2022 to June 2023, the multicenter trial randomized 397 adults from outpatient respiratory disease clinics in a 1:1 ratio. Patients were required to have a diagnosis of COPD, asthma, or bronchiectasis for at least 6 months and had to be current smokers. Patients were excluded if they had active psychiatric disorders, impaired cognitive function, or if they were already on a smoking cessation aid.

Both groups received brief smoking cessation recommendations. The intervention arm was immediately scheduled for an appointment at a smoking cessation outpatient clinic, where they would have access to free smoking cessation therapy, while the control group was advised to make an appointment at a clinic, the standard practice in Turkey.

Access to evidence-based treatment included initiation of pharmacotherapy approved for smoking cessation, such as nicotine replacement therapy (NRT) or bupropion (Zyban). At 3 months, rates were higher in the immediate-appointment arm both for NRT (41% vs 19% in the control arm) and for bupropion (27% vs 12%, respectively; P<0.001 for both).

The primary endpoint of self-reported quit rate at 3 months was analyzed by an intention-to-treat approach and conducted via telephone.

Baseline characteristics in most cases were similar, said Karadogan. Participants were an average age of 54, 33% were women, and they had a mean smoking history of about 38 pack-years . A majority had COPD (55%), while 42% had asthma, and 3% bronchiectasis.

A significantly higher level of education attainment was observed in the immediate-appointment arm, along with higher scores on the Fagerstrom Test for Nicotine Dependence and a greater forced expiratory volume in 1 second. Multivariable analysis that accounted for these differences showed that access to evidence-based cessation support was the only factor significantly associated with successfully quitting smoking (adjusted OR 5.65, 95% CI 2.89-11.03, P<0.001).

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