Fully financed smoking cessation for patients with chronic obstructive pulmonary disease (COPD)

Smoking tobacco is the main risk factor for developing chronic obstructive pulmonary disease (COPD) in Western countries. The effectiveness and clinical utility of behavioural and pharmacological therapy in smoking cessation for COPD patients is well supported by scientific evidence. Nevertheless, tobacco dependency is not specified as a disease by the German law and therefore health insurance companies does not assume the therapy costs. We developed a disease-specific smoking cessation program based on the guidelines. The aim of the model project was to investigate the feasibility and acceptance among patients and physicians. The study was integrated in the regular care setting and consisted of two interventions with varying intensity for smoking patients with an impending or already manifest COPD. 524 Patients in the maximal intervention group received a fully financed structured smoking cessation therapy by resident specialist medical practices. 257 patients in the minimal intervention group received a brief medical consultation with the advice to quit smoking (treatment as usual). In this group, costs for pharmaceutical treatments were not covered. Primary outcome was the abstinence 12 months after treatment, verified by medical examinations and breath gas analysis. Half of the patients of the maximal intervention were smoke-free (intention-to-treat abstinence rate: 38%). In comparison, 8% of the patients of the minimal intervention group quit smoking after 12 months (intention-to-treat abstinence rate: 6%). The positive results and the very high abstinence rate support the request that structured smoking cessation should be part of regular medical care and be reimbursed.