Magic Words for Smoking Cessation — Your Lungs Are 10 Years Older Than You Are

Abstract & Commentary

By Joseph E. Scherger, MD, MPH, Clinical Professor, University of California, San Diego. Dr. Scherger reports no financial relationship to this field of study.

Synopsis: In a British study telling the patient their lung age after spirometry doubled the likelihood of their stopping smoking at one year.

Source: Parkes G, et al. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomized controlled trial. BMJ. 2008;336:567-568.

Telling patients to stop smoking is a vitally important step in smoking cessation although its effectiveness is limited. Smoking cessation programs go beyond this clinical recommendation yet depend on the patient's readiness and willingness to stop. What words might the physician use to motivate a patient to stop smoking?

Parkes, et al, performed a randomized controlled trial of 561 current smokers in five general practices in Hertfordshire, England. All were over age 35. All patients received spirometry to assess lung function and the study subjects were randomized. Smokers in the intervention group were told their "lung age" (the age of the average healthy person who would perform similar to them on spirometry). The control group was given the raw figures for forced expiratory volume at one second (FEV1). Both groups were advised to stop smoking and referred to local National Health Service smoking cessation services.

One-year follow up was available on 89% of the subjects. The quit rate among the intervention group was 13.6% compared with 6.4% for the control group (P = 0.005). The number needed to treat was 14. Smokers with the worst spirometric findings and those with normal lung function were the least likely to quit. A new diagnosis of COPD was made in 16% of the subjects, with comparable findings in both groups.

In this local study in England, telling a person their lung age doubled their likelihood of stopping smoking compared with giving the spirometric results numerically.

Commentary

The art of medicine includes using the right words in the right way to achieve therapeutic results. We all develop our way of saying things to motivate patients to change their lifestyle. Since smoking tobacco remains the leading cause of premature disease and death, counseling patients to stop smoking is of vital importance.

This study has potentially breakthrough information to aid in smoking cessation counseling. The day after reading this study I decided to try it. I work on a Mobile Health Unit in San Diego treating the homeless and uninsured. There is a high prevalence of smoking, even if the patients need to use cigarette butts on the street. I saw a middle-aged woman with longstanding smoking who quickly informed me that she was not going to quit. All the other doctors had asked her to quit to no avail. I suggested to her that her lungs may be 10 years older than she was. That got her attention. She said, "No one has said anything like that before." I do not know if this motivated her to stop, but the information seemed to make an impact, important in the pathway to behavior change.

Most spirometry results do not include a lung age. This can be requested, and based on this study is worth asking for. One local study does not prove that this intervention is successful, but it is certainly worth trying, and studying further in other settings.

Our words are powerful and we all want to improve them to achieve healing effects. I cannot think of any damage this information would have in an addicted smoker. Any longstanding smoker who thinks their lungs are healthy is in denial. Age is an easier concept to grasp than a per cent decline in lung function. I have been projecting the patient into the future, suggesting what they will look like and what their health is likely to be at important future milestones, such as at the wedding of their children or becoming a grandparent. Lung age today takes this concept and applies it to now. I like that.