Quit rates higher when patients know lung age
At 1 year, verified quit rates were 13.6% in the intervention group and 6.4% in the control group (a difference of 7.2%, 95% CI, 2.2%-12.1%; P=.005). This means that for every 14 smokers who are told their lung age and shown a graphic display of this biomarker, 1 additional smoker will quit after 1 year.
Contrary to what might be expected, the investigators found that quitting did not depend on the degree of lung damage. Patients with both normal and abnormal lung age quit smoking at similar rates.
WHAT’S NEW: Lung age resonates more than spirometry alone
This is the first RCT demonstrating that informing smokers of their lung age can help them quit, and the first well-designed study to demonstrate improved cessation rates using a physiological biomarker. The research also suggests that successful quitting may have less to do with spirometry results—the level of severity of lung damage it shows—than with the way the results are presented. Giving patients information about their lung function in an easily understandable format, the authors observe, appears to result in higher quit rates.
CAVEATS: Young smokers weren’t studied
The study did not test to see if this intervention would work in younger adults, as only those 35 years of age and older were enrolled. This is a single study, and it is possible that the findings cannot be generalized to other groups or are due to unmeasured confounding factors. However, the intervention is unlikely to cause any significant harm, so we see no risks associated with it other than the cost of spirometry.
CHALLENGES TO IMPLEMENTATION: Time and expense of spirometry
We suspect the biggest challenges to implementing this recommendation in clinical practice are the expense of obtaining a spirometer ( TABLE ), staff training for those practices without one, and the time needed for the intervention. The average time to perform spirometry on study participants was 30 minutes; a health care worker spent, on average, another 15 minutes reviewing results with each member of the intervention group.
Another challenge: Not all spirometers calculate lung age or can create a graphic similar to FIGURE 2 . However, any FEV1 measurement, whether it is generated by formal pulmonary function testing or by an inexpensive hand-held meter, can easily be converted to lung age using the formula shown in FIGURE 1 . If desired, the same elements—the patient’s age, height, and gender as well as FEV1—could also be used to create a computer-generated graphic display.
TABLE
Spirometry: equipment costs
| The initial cost of a spirometer varies widely, depending on the sophistication of the equipment and the available options and features. Additional costs—for disposable mouthpieces, line filters, nose clips, and hoses, for example—are low. A sampling of reasonably priced models well suited for office use is shown below. All of these models meet American Thoracic Society criteria for spirometry, and all calculate lung age. | ||
|---|---|---|
| SPIROMETER MANUFACTURER/MODEL | PRICE | SUPPLIER |
| Futuremed Discovery-2 | $2,125 | medsupplier.com |
| Micro Medical MicroLoop | $1,780 | Miami-med.com |
| Micro Medical SpiroUSB | $1,580 | Miami-med.com |
| NDD EasyOne Frontline | $1,000 | medsupplier.com |
| SDI Diagnostics Spirolab II | $2,600 | med-electronics.com |
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
PURL METHODOLOGY
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
