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

Abstract

Objective: To evaluate the impact of telling patients their estimated spirometric 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 assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.

Main outcome measures: The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.

Results: Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pounds sterling (366 euros, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.

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

Trial registration: National Research Register N0096173751.

Fig 1 Graph of lung function against age showing how smoking accelerates age related decline in lung function (adapted from Fletcher and Peto11)

Fig 2 Explaining lung age to participants (adapted from Fletcher and Peto11)

Fig 3 Flow of participants through trial