Telling smokers their "lung age" promoted successful smoking cessation.

ED FROM Parkes G, Greenhalgh T, Griffin M, et al. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008;336:598–600. Correspondence to: Dr G Parkes, The Limes Surgery, Hoddesdon, UK; [email protected] Source of funding: Health Foundation. c Clinical impact ratings: GP/FP/Primary care 6/7; Respirology 6/7; Internal medicine 5/7 Reporting spirometry results as ‘‘lung age’’ v simple forced expiratory volume at 1 second (FEV1) to promote smoking cessation* Outcomes at 12 months Results reported as lung age Results reported as FEV1 RBI (95% CI) NNT (CI) Verified smoking cessation 14% 6.4% 112% (25 to 261) 14 (9 to 45) Difference in means (CI) Daily cigarette consumption (mean) 12 14 22.0 (23.8 to 20.2) *Abbreviations defined in glossary. RBI, NNT, and CI calculated from data in article. C O M M EN TA R Y P arkes et al investigated personalised health assessment with normative feedback as a tool to promote smoking cessation. In this trial, smokers who received immediate, verbal information about their lung age were more likely to quit smoking than those who received undigested spirometry results. In thinking about the generalisability of these results, one has to consider that spirometry is not readily available in many primary care practices. Further, spirometry results depend on patients’ effort and cooperation, potentially limiting the reliability of results. Despite these limitations to the practical implementation of spirometry in primary care, Parkes et al showed that the intervention did, in fact, improve quit rates. We do not know whether the key component was the additional counselling time (as part of verbal feedback), graphical presentation, lung-age concept, or something else about the entire intervention package. It is possible that this type of testing– intensive assessment is no better at improving quit rates than estimating lung age from patients’ smoking histories without spirometric testing and presenting it in a personalised, graphical manner. Although this intervention was efficacious, its use alongside other smoking cessation tools is unclear: Should a busy clinician add spirometry, distribute free medications, or use a ‘‘fax to quit’’ programme with a Quitline? The trial by Parkes et al provides 2 bottom-line messages. First, primary care clinicians should consider adding spirometry to routine practice with smokers as a way to increase motivation to quit. Second, if spirometry or other pulmonary function testing is performed, the way in which the results are conveyed to patients seems important. Given the improvement in quit rates, we suggest that the temporary standard (while awaiting further studies) should be to present the results in verbal and graphical forms made relevant to patients’ lives, such as the lung-age concept. Ellie Grossman, MD, MPH Scott Sherman, MD, MPH New York University School of Medicine New York, New York, USA Therapeutics 104 EBM August 2008 Vol 13 No 4 group.bmj.com on October 16, 2017 Published by http://ebm.bmj.com/ Downloaded from