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Chronic Obstructive Pulmonary Disease – Is It Time for Spirometry Screening?
groups or individually on multiple occasions) or brief smoking spirometric ‘lung age’, instead of the spirometric values (FEV
1
), as an
cessation advice in combination with information about nicotine gum incentive to quit smoking:
42
13.6% of participants in the intervention
or pharmacological treatment. In clinical smoking cessation trials, group quit smoking in compared with 6.4% in the control group.
several components of interventions and different combinations of
interventions are often used. The role of spirometry alone Tobacco dependence often requires repeated intervention and
(spirometric testing) as a tool in motivating and improving smoking smoking cessation is a dynamic process.
43
Most smokers go through
cessation rates is unclear.
35,36
Generally, it has been difficult to isolate several stages before they take the decision to make an attempt to
the role of spirometry alone as a motivational tool, since spirometry stop smoking and, at last, succeed. Relapse prevention up to six
has been used in combination with other interventions for smoking months after smoking cessation should therefore be considered.
44,45
cessation such as brief smoking cessation advice, postal smoking To our knowledge, only two studies have been based on a long-term
cessation advice, behavioural support in small groups or individually design with several follow-up visits aimed at preventing relapses and
on multiple occasions, exhaled carbon monoxide (CO), nicotine gum trigger quit attempts. In the Lung Health Study, spirometry was
or pharmacological treatment.
36
Even without these different combined with an intensive behavioural intervention programme, and
components of interventions, it would not be possible to isolate the the smoking cessation rate during five years of follow-up was 22%.
9
In
role and effect of spirometry alone on smoking cessation because it a survey by Stratelis et al., relapse prevention comprised spirometry
is much more than just a test procedure. A spirometry test includes screening and brief smoking cessation advice by a nurse and a
a visit to the PHCC or hospital clinic, and the visit itself may be personal letter from the doctor anually. The smoking cessation rate
regarded as an intervention. A spirometry test also includes a (smoking-free for one year at year three) was 25% in smokers with
conversation and an interaction between the smoker and the COPD compared with 7% in smokers with normal lung function.
41
nurse/physician. It is natural for the nurse/physician to raise
questions on current smoking habits and give smoking cessation Conclusions
advice. It should be considered unethical to avoid at least brief COPD can be easily detected in its pre-clinical stage by using spirometry
smoking cessation advice. Consequently, spirometry in the context of as a targeted, selective screening method that, in combination with
screening for COPD includes all of these components. smoking cessation advice, may prevent progression to a severe
disabling disease. In comparison with ordinary smokers, COPD patients
Studies of the benefits of combining spirometry with smoking seems to be more motivated to stop smoking. COPD patients should
cessation advice have reported varying cessation rates.
9,37–39
In a study repeatedly be offered smoking cessation advice, which, if successfully
by Segnan et al., spirometry combined with smoking cessation advice implemented, will reduce the burden of COPD in our society. ■
resulted in a smoking cessation rate of 6.5%, which was not
significantly different from the 4.5% sustained (one-year) cessation
Georgios Stratelis is a general practitioner. Since 2007,
rate in smokers who received smoking cessation counselling only.
40
In
he has been Director of Respiratory Medicine at
a study by Górecka et al., the cessation rate in smokers with COPD AstraZeneca Sweden. Previously, he was an honorary
one year after the spirometry screening process (prolonged
lecturer at the University of Aberdeen. His main topic of
research is methods for early diagnosis and prevention
prevalence abstinence) was 10.1 versus 8.4% in smokers with normal
of chronic obstructive pulmonary disease (COPD) in
lung function.
38
The cessation rate in spirometry-screened smokers primary care. Dr Stratelis successfully defended his PhD
with moderate and severe COPD was 16.5%. In a study by Bednarek
thesis at the University of Linköping in June 2009.
et al., the sustained (12-month) smoking cessation rate in those with
Jörgen Thorn is an Associate Professor at the
COPD was 16.3% compared with 12% in those with normal lung
Sahlgrenska School of Public Health and Community
function.
39
The impact of spirometry screening in combination with Medicine/Section of Primary Healthcare at the
brief smoking cessation advice was evaluated by Stratelis, and the
University of Gothenburg and Head of the Primary
Health Care Centre at Biskopsgården in Gothenburg. His
one-year cessation rate was 10% compared with 2% in smokers with
main topic of research is chronic obstructive pulmonary
normal lung function.
41
disease (COPD) management in primary healthcare,
with a special focus on spirometry procedures,
programmes for smoking cessation, dietary counselling
In a recent randomised controlled trial Parkes and colleagues
and physical training and osteoporosis.
assessed the effect of telling patients >35 years of age their estimated
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