Twelve-month smoking cessation outcomes following immediate referral in people who smoke with chronic airway diseases: a randomized study

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: 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.