Continued smoking by people with COPD increases hospital admissions and negatively affects morbidity and mortality (Global Initiative for Chronic Obstructive Lung Disease, 2011). Evidence suggests that smokers with COPD have greater dependence on nicotine than those with normal lung functioning (Jiménez-Ruiz et al., 2001) and find it harder to quit (Tashkin & Murray, 2009). However, the SSS are not specifically designed for people with COPD. Target quit rates for the NHS SSS are between 35% and 70% (Willis, 2008). In the United Kingdom, this is the NHS Stop Smoking Services (SSS). The current advice to physicians in the United Kingdom and the United States is that people with COPD should be given advice at every opportunity and, if the person is agreeable, should be referred to a local smoking cessation service (NICE, 2010 Parker & Eaton, 2012). Nevertheless, the proportion of people with COPD continuing to smoke has been estimated between 32.8% and 70% (Baron, 2003 Vozoris & Stanbrook, 2011) and could be rising (Vozoris & Stanbrook, 2011). Current best practice advises that people with COPD be encouraged to quit smoking and given all necessary psycho-social and/or pharmacological support to do so (NICE, 2010). To date, the only intervention found to slow the decline in lung functioning is smoking cessation (Anthonisen et al., 1994). The prevalence and costs associated with COPD are expected to rise in the coming years (Parker & Eaton, 2012), and by 2020, it is estimated that COPD will be the third leading cause of death worldwide (World Health Organisation, 2002). In 2004, COPD was estimated to cost the National Health Service (NHS) £800 million in direct care costs and was responsible for 24 million lost work days (DoH, 2005). Approximately 80% of cases are linked to smoking (DoH, 2005) with the other 20% due to a combination of environmental and genetic factors (National Institute for Health and Clinical Excellence, 2010). While pharmacological support has been detailed, and effectiveness ranked, the content of behavioural counselling varies between interventions, and it is not clear what the most effective components are.Ĭhronic obstructive pulmonary disease (COPD) is a term used to describe progressive, non-reversible airflow obstruction (Department of Health, 2005).
Previous reviews of smoking cessation interventions for this population have established that a combination of pharmacological support and behavioural counselling is most effective.
What is already known on this subject? Chronic obstructive pulmonary disease (COPD) is responsible for considerable health and economic burden worldwide, and smoking cessation (SC) is the only known treatment that can slow the decline in lung function experienced. Additional RCTs that use standardized reporting of intervention components and BCTs would be valuable to corroborate findings from the present meta-analysis. Smoking cessation interventions aimed at people with COPD appear to benefit from using techniques focussed on forming detailed plans and self-monitoring. Three new COPD-specific BCTs were identified, and Linking COPD and smoking was found to result in significantly larger effect sizes. Four techniques were associated with significantly larger effect sizes: Facilitate action planning/develop treatment plan, Prompt self-recording, Advise on methods of weight control, and Advise on/facilitate use of social support. Thirty-seven BCTs were each used in at least three interventions. The sample-weighted mean quit rate for all RCTs was 13.19%, and the overall sample-weighted effect size was d + = 0.33. Seventeen randomized controlled trials (RCTs) were identified that involved a total sample of 7446 people with COPD. Data were extracted and weighted average effect sizes calculated BCTs used were coded according to an existing smoking cessation-specific BCT taxonomy. Web of Knowledge, CINAHL, EMBASE, PsycINFO, and MEDLINE were searched from the earliest date available to December 2012. MethodsĪ systematic review and meta-analysis was conducted. The purpose of this study was to identify the behaviour change techniques (BCTs) that are associated with greater effectiveness in smoking cessation interventions for people with chronic obstructive pulmonary disease (COPD).
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