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Clinical ethics
Ethical analysis of the justifiability of labelling with COPD for smoking cessation
  1. D Kotz1,
  2. R Vos2,
  3. M J H Huibers3
  1. 1
    Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2
    Department of Health, Ethics & Society, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3
    Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Daniel Kotz, Department of General Practice, School for Public Health and Care (CAPHRI), Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, Maastricht, The Netherlands; d.kotz{at}


Background: Spirometry for early detection of chronic obstructive pulmonary disease (COPD) and smoking cessation is criticised because of the potential negative effects of labelling with disease.

Aim: To assess the effects of opinions of smokers with mild to moderate COPD on the effectiveness of spirometry for smoking cessation, the justification of early detection of airflow limitation in smokers and the impact of confrontation with COPD.

Design: Qualitative study with data from a randomised controlled trial.

Setting: General population of Dutch and Belgian Limburg.

Methods: Semistructured ethical exit interviews were conducted with 205 smokers who were motivated to quit smoking and had no prior diagnosis of COPD but were detected with airflows limitation by means of spirometry. They received either (1) counselling, including labelling with COPD, plus with nortriptyline for smoking cessation, (2) counselling excluding labelling with COPD, plus nortriptyline for smoking cessation or (3) care as usual for smoking cessation by the general practitioner, without labelling with COPD.

Results: Of the participants, 177 (86%) agreed or completely agreed that it is justified to measure lung function in heavy smokers. These participants argued that measuring lung function raises consciousness of the negative effects of smoking, helps to prevent disease or increases motivation to stop smoking. Most of the 18 participants who disagreed argued that routinely measuring lung function in smokers would interfere with freedom of choice.

Conclusions: Labelling with disease is probably a less important issue in the discussion about the pros and cons of early detection of COPD.

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  • Funding This study was funded by grants from the Dutch Asthma Foundation, Partners in Care Solutions for COPD (an initiative of CAPHRI School for Primary Care and Public Health, Boehringer Ingelheim, and Pfizer) and Maastricht University Medical Centre.

  • Competing interests None.

  • Ethics approval The trial was approved by the medical ethics committee of Maastricht University and Maastricht University Hospital and registered at the Netherlands Trial Register (ISRCTN 64481813). The work was performed at Maastricht University Medical Centre, The Netherlands.

  • Provenance and Peer review Not commissioned; externally peer reviewed.