Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

doi:10.1136/bmj.39503.582396.25

BMJ 2008;336:598-600 (15 March), doi:10.1136/bmj.39503.582396.25 (published 6 March 2008)

Research

Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

Gary Parkes, general practitioner¹, Trisha Greenhalgh, professor ², Mark Griffin, lecturer in medical statistics², Richard Dent, consultant chest physician department of chest medicine³

¹ The Limes Surgery, Hoddesdon, Hertfordshire EN11 8EP, ² Department of Primary Care and Population Sciences, University College London, London N19 5LW, ³ Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire AL7 4HQ

Correspondence to: G Parkes Parkesko{at}hotmail.co.uk

Objective To evaluate the impact of telling patients their estimatedspirometric lung age as an incentive to quit smoking.

Design Randomised controlled trial.

Setting Five general practices in Hertfordshire, England.

Participants 561 current smokers aged over 35.

Intervention All participants were offered spirometric assessmentof lung function. Participants in intervention group receivedtheir results in terms of "lung age" (the age of the averagehealthy individual who would perform similar to them on spirometry).Those in the control group received a raw figure for forcedexpiratory volume at one second (FEV₁). Both groups were advisedto quit and offered referral to local NHS smoking cessationservices.

Main outcome measures The primary outcome measure was verifiedcessation of smoking by salivary cotinine testing 12 monthsafter recruitment. Secondary outcomes were reported changesin daily consumption of cigarettes and identification of newdiagnoses of chronic obstructive lung disease.

Results Follow-up was 89%. Independently verified quit ratesat 12 months in the intervention and control groups, respectively,were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidenceinterval 2.2% to 12.1%; number needed to treat 14). People withworse spirometric lung age were no more likely to have quitthan those with normal lung age in either group. Cost per successfulquitter was estimated at £280 ( ${euro}$ 366, $556). A new diagnosisof obstructive lung disease was made in 17% in the interventiongroup and 14% in the control group; a total of 16% (89/561)of participants.

Conclusion Telling smokers their lung age significantly improvesthe likelihood of them quitting smoking, but the mechanism bywhich this intervention achieves its effect is unclear.

Trial registration National Research Register N0096173751.

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Study’s conclusion about screening is unwarranted: Kenneth W Lin
BMJ 2008 336: 1034. [Extract] [Full Text] [PDF]

Incentives to quit smoking in primary care: Raphaël Bize and Jacques Cornuz
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Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross sectional case finding study: C P van Schayck, J M C Loozen, E Wagena, R P Akkermans, and G J Wesseling
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This article has been cited by other articles:

Lin, K. W (2008). Study's conclusion about screening is unwarranted. BMJ 336: 1034-1034 [Full text]
Spiegelhalter, D. J. (2008). Understanding Uncertainty. Ann Fam Med 6: 196-197 [Full text]
(2008). Telling Smokers Their Lung Age Increases Their Likelihood of Quitting. JWatch General 2008: 9-9 [Full text]
Bize, R., Cornuz, J. (2008). Incentives to quit smoking in primary care. BMJ 336: 567-568 [Full text]

Rapid Responses:

Read all Rapid Responses

Usefulness of lung age: Hiroshi Kawane, et al.
bmj.com, 7 Mar 2008 [Full text]
comparison with counselling: Rajasree Pai R
bmj.com, 8 Mar 2008 [Full text]
Age to peak flow readings?: John J. Kivlighan
bmj.com, 9 Mar 2008 [Full text]
"lung age" is both physical and mental index: Xiaofeng Ren
bmj.com, 9 Mar 2008 [Full text]
Re: Age to peak flow readings?: Gary Parkes
bmj.com, 10 Mar 2008 [Full text]
Lung age by spirometry: Anthony N Glaser
bmj.com, 17 Mar 2008 [Full text]
Re: Lung age by spirometry-reply-re:calculator: Gary Parkes
bmj.com, 17 Mar 2008 [Full text]
Looking Beyond Lung Age: Dr Manoj K. Saraswat, et al.
bmj.com, 19 Mar 2008 [Full text]
Stress, Tobacco Control and the Insula: Jay R. Schrand
bmj.com, 27 Mar 2008 [Full text]
Lung age by spirometry: Kathy Hartley, et al.
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Re: Lung age by spirometry: Gary Parkes, et al.
bmj.com, 1 Apr 2008 [Full text]
Why the new UK NHS GP contract should not include incentives for spirometric assessment in smokers: Alberto Donzelli
bmj.com, 8 Apr 2008 [Full text]
Should we use lung age?: Philip H Quanjer
bmj.com, 16 Apr 2008 [Full text]
Study's conclusion about screening is unwarranted: Kenneth W Lin
bmj.com, 16 Apr 2008 [Full text]
Lung age should be compared to FEV1 percent predicted: Rei Suganaga, et al.
bmj.com, 5 May 2008 [Full text]