Theory-Based Smoking Cessation Interventions Positively Affect Patients With COPD Who Smoke

Implementing theory-based smoking cessation interventions can positively affect smoking cessation rates, lung function, and quality of life in patients with chronic obstructive pulmonary disease (COPD) who smoke, according to a study published in BMC Public Health.

The researchers noted that smokers have a 10-fold greater risk of developing COPD compared with nonsmokers, and “smoking cessation is considered the most effective and cost-effective strategy for preventing and treating COPD.” They explained that theory-based smoking cessation interventions have shown promising results but have not been systematically evaluated or meta-analyzed within patients with COPD who smoke.

Because of this, the researchers conducted a study that synthesized “randomized clinical trials (RCTs) of theory-based cessation interventions in patients with COPD and evaluated their effectiveness.”

They searched for RCTs using various databases, including PubMed and Web of Science, with search terms like COPD, smoking cessation, and smoking intervention. The researchers established criteria to determine which studies they analyzed. For example, they analyzed studies that included RCTs and theory-based smoking cessation methods and they excluded studies that had incomplete data or no relevant outcome indicators.

The researchers determined the studies’ biases using a quality assessment of 7 items: random sequence generation, allocation concealment, blinding of outcome assessment, blinding of participants and personnel, incomplete outcome data, selective reporting, and other biases. They gave studies an A quality level if they met all the above criteria, indicating a low possibility of various biases. Those given a B quality rating met some of the criteria and had a moderate possibility of bias occurring, and studies with a C quality rating did not meet any of the above criteria and had a high possibility of bias.

woman breaking a cigarette in half | Image credit: zinkevych - stock.adobe.com.

Of 432 relevant articles, the researchers narrowed their population to 11 articles published between 2013 and 2023; 9 were in Chinese and 2 in English. They graded each at B quality, meaning they contained high-quality evidence, a low risk of bias, and a fair methodological quality of literature. The studies examined 3830 patients, 1989 of which were in the experimental group and 1841 in the control group.

As for the types of intervention theories used, 7 studies used the timing theory, 2 used cognitive behavioral theory, and 2 used the 5A nursing model. The timing theory determines smoking cessation strategies based on the disease stage of patients with COPD, cognitive behavioral therapy “emphasizes the importance of addressing patients’ smoking-related thoughts and behaviors for successful smoking cessation,” and the 5A nursing model “involves individualized assessment, setting goals, and providing help and regular follow-up” to alter how patients with COPD think about the disease and smoking-related harm.

The study suggested that theory-based interventions can improve smoking cessation rates in patients with COPD. The researchers found that smoking cessation interventions occurring at different times were more effective in increasing smoking cessation rates than in the control group (odds ratio [OR], 4.04; 95% CI, 3.23-5.06; P < .001). The researchers attributed this to the patient-focused strategies helping them develop a strong desire to quit and act on it.

The researchers also found that lung function was more positively affected by theory-based smoking cessation interventions in the experimental group than in the control group (mean difference [MD], 0.51; 95% CI, 0.28-0.74; P < .001). Its positive impact on patients quitting smoking may contribute to slowing down the progression of COPD and improving patients’ overall respiratory health. Similarly, the study found that theory-based smoking cessation interventions positively affected the quality of life within patients with COPD who smoke compared to the control group (MD, –4.87; 95% CI –6.34 to –3.40; P < .001).

“By addressing both the physical and psychological aspects of smoking behavior, theory-based interventions may help improve patient’s overall well-being and quality of life,” the authors wrote.

The researchers could not determine how theory-based smoking cessation interventions affected nicotine dependence (OR, 1.00; 95% CI 0.78-1.29; P < .001). They attributed this lack to several factors, including the “relatively short duration of the interventions and follow-up periods in the included studies, as well as potential differences in the measurement and reporting of nicotine dependence levels across studies.”

Despite their findings, the authors acknowledged limitations to their study, one being that they only analyzed publicly available studies in Chinese and English, which may have resulted in an incomplete literature collection.

In terms of future research, the authors noted that their findings need further investigation to achieve higher quality levels.

Reference

Han M, Fu Y, Ji Q, Deng X, Fang X. The effectiveness of theory-based smoking cessation interventions in patients with chronic obstructive pulmonary disease: a meta-analysis. BMC Public Health. 2023;23(1):1510. doi:10.1186/s12889-023-16441-w