Intervention Review

Biomedical risk assessment as an aid for smoking cessation

  1. Raphaël Bize1,*,
  2. Bernard Burnand2,
  3. Yolanda Mueller3,
  4. Myriam Rège Walther4,
  5. Jacques Cornuz5

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 15 APR 2009

Assessed as up-to-date: 26 JAN 2009

DOI: 10.1002/14651858.CD004705.pub3

Database Title

Additional Information

How to Cite

Bize R, Burnand B, Mueller Y, Rège Walther M, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004705. DOI: 10.1002/14651858.CD004705.pub3.

Author Information

  1. 1

    University of Lausanne, Department of Ambulatory Care and Community Medicine & Clinical Epidemiology Centre, Lausanne, Switzerland

  2. 2

    Institute of Social and Preventive Medicine, University of Lausanne, Health Care Evaluation Unit & Clinical Epidemiology Centre, Lausanne, Switzerland

  3. 3

    Institute of Social and Preventive Medicine, University of Lausanne, Clinical Epidemiology Centre, Lausanne, Switzerland

  4. 4

    University Institute of Social and Preventive Medicine, Health Care Evaluation Unit, 1005 Lausanne, Switzerland

  5. 5

    University of Lausanne, Department of Ambulatory Care and Community Medicine, Lausanne, Switzerland

*Raphaël Bize, Department of Ambulatory Care and Community Medicine & Clinical Epidemiology Centre, University of Lausanne, Bugnon 44, Lausanne, CH-1011 , Switzerland. raphael.bize@hospvd.ch.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer.

Objectives

To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation.

Search methods

We systematically searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials 2008 Issue 4, MEDLINE (1966 to January 2009), and EMBASE (1980 to January 2009). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements.

Selection criteria

Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention.

Data collection and analysis

Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate a pooled effect was estimated using a Mantel-Haenszel fixed effect method.

Main results

We included eleven trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that CO measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other seven trials. One trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12; 95% CI 1.24 to 3.62). One trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77; 95% CI 1.04 to 7.41) but enrolled a population of light smokers. Five trials failed to detect evidence of a significant effect. One of these tested CO feedback alone and CO + genetic susceptibility as two different intervention; none of the three possible comparisons detected significant effects. Three others used a combination of CO and spirometry feedback in different settings, and one tested for a genetic marker.

Authors' conclusions

There is little evidence about the effects of most types of biomedical tests for risk assessment. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. Only two pairs of studies were similar enough in term of recruitment, setting, and intervention to allow meta-analysis.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Does giving people who smoke feedback about the effects of smoking on their body help them to quit

Biomedical risk assessment is the process of giving smokers feedback on the physical effects of smoking by physiological measurements (for example: exhaled carbon monoxide measurement or lung function tests). It was thought to be a possible way of increasing quit rates. In one study, smokers who had their lung function tested and the results explained in terms of their lung age compared to a non smoker of the same age were more likely to quit than people given the same test but without the explanation. Mixed quality evidence does not suggest that other types of biomedical risk assessment increases smoking cessation compared with standard treatments.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

用生物醫學危險評估來幫助戒菸.

一個可能增加戒菸率的策略為提供接觸醫療保健系統的吸煙者，有關生物醫學或抽菸未來潛在影響的回饋，例如測量呼出的一氧化碳，肺功能，或肺癌遺傳易感性

目標

除了各個層次的輔導之外，確認生物醫學危險評估作為一個幫助戒菸方式的療效

搜尋策略

我們系統地搜查Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials 2008 Issue 4, MEDLINE (1966 to January 2009), and EMBASE (1980 to January 2009)。我們結合方法學名詞與有關的戒菸輔導和生物醫學測量的名詞

選擇標準

納入標準：隨機對照試驗的研究設計;參與戒菸介入的受試者;介入的方式是基於生物醫學測試來增加戒菸的動機;對照組是所有其他介入;戒菸率的結果是在開始介入後至少6個月

資料收集與分析

兩個評估者獨立執行每一個論文的資料擷取,若看法不一至的話進行共識討論。戒菸結果以相對風險(relative risks, RR)及其95%信賴區間(confidence intervals, CI)呈現。若統合結果是適當的，採用MantelHaenszel 固定效益方法(fixed effect method)進行預估

主要結論

我們納入11個試驗包含各種生物醫學檢驗。兩對研究有足夠相同的個案登錄，場所與介入可以計算統合效果。在初級照護中，沒有足夠的證據顯示一氧化碳測量(RR 1.06, 95% CI 0.85 to 1.32)或肺功能計量(RR 1.18, 95% CI 0.77 to 1.81)能夠增加戒菸率。我們並沒有將另外7篇的試驗結果統合，其中一篇提到將肺功能計量顯示的肺年齡(lung age)回饋法，在初級照護中對戒菸有助益(RR 2.12; 95% CI 1.24 to 3.62)。另外，以超音波檢查頸動脈及股動脈並將斑塊(plaques)的照片呈現也有助益(RR 2.77; 95% CI 1.04 to 7.41)，只是此試驗包含輕吸煙者。剩餘5個研究結果證據都未達顯著差異。其中之一以單獨使用與使用一氧化碳加上基因易感性作為兩個不同的介入，三個可能的比較沒有顯著療效差異。3個其他試驗使用合併一氧化碳測量和肺功能計量回饋於不同的場所，以及一個測試基因標記

作者結論

只有一些證據顯示以生物醫學測驗危險評估來幫助戒菸的效果。個別一篇高品質研究顯示，採用肺功能計量顯示的肺年齡回饋法明顯有效。品質不一的證據無法支持其他種類的生物醫學危險評估比標準治療對戒菸更有效。只有兩對研究有足夠相同的個案登錄，場所與介入可以計算統合分析

翻譯人

本摘要由彰化基督教醫院李謙益翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

生物醫學危險評估的過程是利用生理評量有關吸菸對身體的影響給予吸煙者回饋(例如：呼出的一氧化碳測量或肺功能測試)。它被認為是一個增加戒菸率可行的辦法。一個研究顯示，吸菸者被測試肺功能後以肺年齡加以解釋(相對於同年紀未吸菸者)，比只有被測試但是沒有解釋的吸菸者，前者有較高可能戒菸成功。品質不一的證據無法支持其他種類的生物醫學危險評估比標準治療對戒菸更有效

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