JMIR Publications

ABSTRACT

Background:

Most smokers with COPD have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation while also facilitating COPD screening could address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of the present study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit that could be delivered proactively to adult smokers at risk for COPD treated within primary care.

Objective:

The aims of the present study were: 1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFTs), and 2) to examine efficacy of cessation e-visits relative to treatment as usual (TAU), all within primary care.

Methods:

Randomized clinical trial (N=125) of primary care patients who smoke randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores 2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best FDA-approved cessation medication to prescribe. Primary outcomes included measures related to 1) e-visit acceptability, feasibility, and treatment metrics, 2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction 50%, self-reported abstinence, biochemically confirmed abstinence), and 3) COPD screening outcomes.

Results:

Of 85 participants assigned to the e-visits, 64 (75.3%) were invited to complete home spirometry and in-lab PFTs based on the CAPTURE. Among those eligible for spirometry, 76.6% completed home spirometry and 35.9% completed in-lab PFTs. At 1-month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (OR=3.22). At 3-months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09).

Conclusions:

A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad intervention within primary care. Clinical Trial: NCT04155073