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Role of spirometric testing in smoking cessation
Pulmonary function testing offers an easy, inexpensive, and non-invasive means of diagnosing and staging chronic lung disease.1,2 It provides information on both the presence of obstructive lung disease and restrictive lung disease and can provide insights on how patients might respond to treatment.3,4 Spirometric testing also provides prognostic information, with lung function measures predicting mortality and the development of lung cancer.5,6
Despite the valuable information that spirometric testing provides, it is underused in medical practices in much of the world. There are several reasons for this, including (1) problems with doing the procedure,7 (2) problems related to compensation, and (3) the absence of “evidence” that spirometric testing actually makes a difference in the diagnosis and treatment of patients. Advances in the design of spirometric tests that provide quality control feedback are addressing the first reason. The second reason varies between locales and health plans. Addressing the final reason is critical to increasing the use of spirometry in a general medical practice.
A recent review commissioned by the United States’ Agency for Health Research and Quality by Wilt et al8 concluded that “the evidence does not support widespread use of spirometry in primary care settings for all adults with persistent respiratory symptoms or having a history of exposure to pulmonary risk factors for case-finding, improving smoking cessation rates, monitoring the clinical course of COPD, or adjusting COPD interventions”. With specific regard to smoking cessation, the report’s review of four studies in the literature concluded the following:
“Spirometric testing as a motivational tool to improve smoking cessation rates is unlikely to provide more than a small benefit. Results from observational studies of spirometry are mixed. RCT of other biomarkers used as motivational tools for smoking cessation are generally negative. The only randomized controlled trial that assessed the independent contribution of spirometry and counseling on smoking cessation rates reported a nonsignificant 1 percent greater quit rate at 12 months in the group assigned to receive spirometry …”.8
The paper in this issue of Thorax by Bednarek et al,9 which is observational and not a randomised clinical trial, would not have been included in the review by Wilt et al and thus would not have changed the conclusion. The information in the study by Bednarek et al is, however, compelling. Their evidence suggests that spirometric testing, with a very quick and simple feedback consisting of a lung function decline curve marked with the patient’s value, improved smoking cessation. In the world of smoking cessation, the validated cessation rates at 1 year of 16.3% in the overall group was higher than the expected 4–6%,10,11 and there was evidence that lower lung function at baseline resulted in higher cessation rates. Even though this was not a randomised trial, these results are remarkable and should be a model for designing a study to determine whether this quick and simple intervention can improve cessation in other populations.
Does spirometric screening work? For this group of men from Poland, the answer—with regard to increasing smoking cessation—appears to be a qualified yes. Those of us interested in decreasing the most preventable cause of death and disease in the developed world now have a road map to help us design studies for implementation in our own populations.
Competing interests: none declared.
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