Family based screening and smoking cessation for COPD detection: Hybrid cross-sectional and single-arm, multicenter intervention study

Chronic obstructive pulmonary disease (COPD) is the third leading cause of morbidity and mortality, making early detection crucial to improving prognosis. This study aimed to identify new cases of COPD, clinical profiles, and predictors among smokers and their cohabiting family members seeking help to quit smoking.

A hybrid cross-sectional and single-arm intervention study was conducted over one year across 8 Primary care centers in the Santiago-Barbanza health area (Galicia, Spain), including 217 participants (index smokers and cohabitants without contraindications for spirometry). Clinical variables for diagnosis and characterization of the patient with COPD were analyzed, as well as variables associated with smoking (degree of smoking, motivation, nicotine dependence or abstinence at 6 months). The intervention involved: 1) performing forced spirometry on active smokers and cohabitants exposed to tobacco smoke for >20 years; and 2) enrolling smoking family members into a cessation program. Descriptive statistics, univariate analysis, and multivariate logistic regression were used to identify independent risk factors (adjusted odds ratio, AOR, and 95% CI).

Out of 217 participants (104 family members), 147 (67.8%) were active smokers. Over 40% reported respiratory symptoms, with dyspnea being the most frequent. Spirometric abnormalities were present in 99 participants (45.6%), identifying 53 new COPD cases (24.4%), with 58.5% in the mild stage (GOLD I). Among cohabitants, 17 additional cases (15%) were detected regardless of smoking status. Cumulative smoking exposure time (AOR=1.04; 95% CI: 1.03-1.10; p=0.006) and respiratory symptoms (AOR=3.90; 95% CI: 1.25-10.00; p=0.036) were independent risk factors. This strategy led to the inclusion of 38 additional smokers in the cessation program, 25 of whom successfully quit.

Active screening for COPD in smokers and their cohabitants facilitates early-stage diagnosis, potentially altering disease progression while increasing family engagement in smoking cessation programs.