Remote smoking cessation programme delivers encouraging results in high-risk individuals

A smoking cessation intervention delivered via telephone resulted in greater smoking cessation rates than usual care among individuals enrolled in targeted lung health screening, according to results of the QuLIT*2 study from the UK presented at ERS 2022.

“Immediate provision of an intensive telephone smoking cessation intervention, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3 months,” said the authors.

Participants were 315 current smokers aged 55–75 years (mean age 63 years, 48 percent female, 85 percent White) who attended a Targeted Lung Health Check (TLHC). They were randomized, single-blind, to receive either six sessions of smoking cessation support via telephone (initiated immediately and lasting for 6 weeks) plus pharmacotherapy (varenicline or nicotine replacement therapy; intervention group; n=152) or usual care (very brief advice on quitting smoking and signposting to smoking cessation services; n=163). Smoking cessation counselling was provided by specialist research nurses who had undergone specific smoking cessation training programmes.

Participants started smoking at a mean age of 18 years and had smoked an average of 41–43 years, smoking an average 12.5–12.6 cigarettes/day.

Eighty of the 152 participants in the intervention arm declined smoking cessation support, with 57 of the remaining 72 enrolling in the full smoking cessation programme (16 participants dropped out after the first session). Sixty-one percent of participants completed all six sessions.

At 3 months, self-reported quit rates (defined as no smoking or use of tobacco products in the past 7 days) were greater among participants who received the intervention than usual care (21.1 percent vs 8.9 percent; odds ratio [OR], 2.83, 95 percent confidence interval [CI], 1.44–5.60; p=0.002). [ERS 2022, ALERT 2 session; Chest 2022; doi:10.1016/j.chest.2022.06.048]

At 3 months, a greater proportion of participants who received the intervention than usual care had attempted to quit smoking, defined as an attempt to quit smoking that lasted 1 day (37.5 percent vs 22.0 percent; OR, 2.11, 95 percent CI, 1.29–3.47; p=0.003).

Undergoing a CT scan did not influence the likelihood of quitting smoking, be it in the usual care group (6.7 percent vs 9.5 percent [without vs with CT scan]; OR, 0.68; p=0.53) or the intervention group (26.9 percent vs 18 percent; OR, 1.67; p=0.23).

“These data do support the offer of smoking cessation support to everyone taking part in TLHC, not only those whose risk score means that they qualify for low-dose CT imaging,” the authors said.

In an attempt to quit smoking, participants in the intervention group were more likely than those in the usual care group to use smoking cessation pharmacotherapy (OR, 20.90; p≤0.001), while those in the usual care group were more likely to use e-cigarettes than those in the intervention group (30.5 percent vs 14.0 percent).

Factors such as participant demographics (eg, age, sex), smoking characteristics at baseline (eg, average number of cigarettes smoked/day, years of smoking), or abnormalities on low-dose CT imaging did not appear to influence quit rates.

Previous results from the QuLIT1 trial showed that an immediate face-to-face intervention was better than usual care at leading to smoking cessation in patients attending lung screening (29.2 percent vs 11 percent).

The present results suggest that the intervention, delivered remotely to high-risk individuals, was also more successful in leading to smoking cessation than usual care in this group of participants, said the authors. As such, research comparing the two strategies is necessary to identify the more effective method.

“Both QuLIT1 and 2 suggest improved quit rates with early intervention delivery, either face to face or remotely, compared with usual care,” the authors noted.

Despite the effectiveness of an in-person smoking cessation strategy, the remote intervention could potentially be more accessible “particularly for people living in remote and low-income areas,” they added. The results also highlight the importance of pharmacological therapy in the smoking cessation strategy.

“It is likely that a combination of delivery options and pharmacotherapy will be most appropriate for a population with varying needs and preferences,” they said.