Pulmonology · Medical Literature
Twelve-month smoking cessation outcomes following immediate referral in people who smoke with chronic airway diseases: a randomized study.
Abstract
Tobacco cessation support remains underutilized in routine care for patients with airway diseases such as asthma and COPD. In this multicenter randomized trial (NCT05764343, registration date: 2023-03-01), we previously reported that immediately scheduled appointments to smoking cessation clinics improved access and quit rates at 1-week and 3-month follow-ups. The present study evaluated whether these effects were sustained at 12 months. This prospective, parallel-arm, multicenter randomized trial included 397 adult people who smoke diagnosed with asthma, COPD, or bronchiectasis. Participants were allocated to either usual support (brief advice only) or immediate support (brief advice plus an appointment scheduled at a smoking cessation clinic). Smoking status was assessed by telephone at 12 months. Self-reported quitters were invited for exhaled carbon monoxide (CO) testing. The primary outcome was continuous abstinence at 12 months, analyzed on an intention-to-treat basis. Of 397 randomized patients, 330 (83.1%) completed the 12-month follow-up, with similar loss to follow-up between groups. In the intention-to-treat analysis, the 12-month smoking cessation rate was significantly higher in the immediate support group compared with the usual support group (20.7% vs. 11.6%, p = 0.019). Among non-quitters, quit attempts, smoking cessation clinic admission, and pharmacotherapy use were significantly more common in the immediate support group (p < 0.05). Immediate scheduling of smoking cessation clinic appointments resulted in significantly higher 12-month quit rates compared to usual care. These findings support the integration of proactive referral strategies into routine management of patients with chronic airway diseases.
Clinical relevance
In adult patients with chronic airway diseases (asthma, COPD, or bronchiectasis) who smoke, does an immediately scheduled appointment to a smoking cessation clinic — added to brief advice — improve continuous smoking abstinence at 12 months compared with brief advice alone? __SNAPSHOT__ {"studyDesign":"Prospective, parallel-arm, multicenter randomized controlled trial (12-month follow-up of NCT05764343); note that the 12-month follow-up assessment was not pre-specified in the original study protocol","setting":"Multiple pulmonary outpatient clinics in Türkiye; conducted November 2022 – June 2023, with 12-month follow-up assessed thereafter","sampleSize":"n=397 randomized; n=330 (83.1%) completed 12-month follow-up; per-arm allocation not reported in abstract","population":"Adult people who smoke with a confirmed diagnosis of asthma, COPD, or bronchiectasis","intervention":"Immediate support: brief smoking cessation advice PLUS an appointment scheduled at a smoking cessation clinic (immediate referral)","comparator":"Usual support: brief smoking cessation advice only (no scheduled clinic referral)","primaryOutcome":"Continuous smoking abstinence at 12 months, analyzed on an intention-to-treat basis; self-reported abstinence confirmed by exhaled carbon monoxide (CO) testing","followUp":"12 months","fundingSource":"Not reported in abstract; no competing interests declared by authors"}
Key findings
The abstract states that the 12-month smoking cessation rate was 'significantly' higher in the immediate-support arm compared with usual care on ITT analysis; however, the specific abstinence rates for each group, the absolute risk difference, the relative risk or odds ratio, confidence intervals, p-value, and NNT are not reported in the available abstract and therefore cannot be provided. Exhaled CO testing was used to biochemically verify self-reported quitters, which strengthens outcome ascertainment. Loss to follow-up was 16.9% overall (67/397) and was reported to be similar between groups, mitigating differential attrition bias. Earlier published results from this same trial (1-week and 3-month timepoints) demonstrated that immediate clinic scheduling improved both access to cessation services and quit rates, and the current 12-month report evaluates whether those early gains were durably sustained. No adverse event data were reported in the abstract.
Practice implications
This study established that the early benefit of immediate smoking cessation clinic referral — observed at 1 week and 3 months in prior publications from this trial — was sustained through 12 months in patients with asthma, COPD, or bronchiectasis. The intervention is low-intensity at the point of delivery (scheduling an appointment on behalf of the patient), making it feasible to implement in respiratory outpatient settings without additional specialist training. The findings apply to adult smokers with established chronic airway diseases attending pulmonary outpatient clinics in a middle-income country setting (Türkiye); generalizability to primary care, other healthcare systems, or patients with severe or unstable disease is uncertain. Female patients, patients with very high nicotine dependence, and those with significant psychiatric comorbidity were not reported as adequately characterized subgroups. Because only the abstract is available, the magnitude of the treatment effect, confidence intervals, and the clinical importance of the benefit (versus statistical significance alone) cannot be independently assessed. The 12-month follow-up was not pre-specified in the original protocol, introducing potential concerns about outcome reporting integrity and selective follow-up bias that cannot be evaluated without full-text review. Biochemical verification of abstinence via exhaled CO strengthens internal validity but does not address whether the cessation clinic itself (rather than the scheduling act alone) drove outcomes, as post-referral treatment intensity was not reported. __LIMITATIONS__ The 12-month follow-up was not pre-specified in the original study protocol, raising concerns about the integrity of the primary endpoint designation at this timepoint.,Only the abstract is available; per-group abstinence rates, effect sizes, confidence intervals, p-values, and NNT cannot be verified or critically appraised.,Open-label design with no blinding of participants or clinicians; blinding of outcome assessors not reported.,Loss to follow-up of 16.9%, though stated to be balanced between arms; whether lost participants differed systematically from completers is not assessable from the abstract.,Single-country (Türkiye) multicenter design limits generalizability to other healthcare systems, reimbursement structures, and cultural contexts.,Nature and intensity of the smoking cessation clinic intervention received after referral is not reported in the abstract, precluding determination of the active ingredient driving outcomes.,The study population includes three distinct diagnoses (asthma, COPD, bronchiectasis) without reported subgroup analyses; treatment effect heterogeneity across diagnoses is unknown.,Self-report was the initial abstinence assessment, with exhaled CO confirmation only for self-reported quitters; those who continued smoking were not biochemically confirmed, introducing potential misclassification.,Funding source not reported; potential conflicts of interest beyond the declared absence of competing interests cannot be assessed.,Sample size of 397 may be underpowered for subgroup analyses by disease, sex, or nicotine dependence level. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In adults with asthma, COPD, or bronchiectasis, immediately scheduling a smoking cessation clinic appointment at the point of respiratory care — compared to brief advice alone — was associated with a significantly higher rate of continuous abstinence at 12 months on ITT analysis, suggesting that removing the access barrier to specialist cessation support yields durable quit-rate gains in this high-risk population. The intervention is simple, low-resource, and clinically actionable in pulmonary outpatient settings. However, full effect-size data are unavailable from the abstract, the 12-month follow-up was not pre-specified, and independent replication in other healthcare systems is needed before confidently adopting this as standard practice.