A new study suggests that smokers with chronic obstructive pulmonary disease react poorly to confrontational therapy aimed at getting them to quit smoking.

A frank discussion of a smoker's 'lung age,' based on a demonstration of spirometry data, had been considered a possible method to motivate patients to accept the need to stop smoking, but the new data suggest otherwise.

"Confrontational counseling may have short-term effects, but these diminish during the first year after initial counseling treatment," said lead study author Daniel Kotz of the Maastricht University Medical Center in the Netherlands.

In this study, patients were assigned to receive confrontational counseling by a nurse with nortriptyline for smoking cessation, regular counseling by a nurse with nortriptyline, or "care as usual" for smoking cessation by their family physician. Only the first group was confronted with their abnormal spirometry results.

No difference in cotinine-validated prolonged abstinence was found between the experimental group (11.2 percent) and the group receiving regular counseling (11.6 percent) from week 5 through week 52 of the study.

"The high failure rates dramatically emphasize the difficulty tobacco-addicted smokers experience with quitting smoking and highlight the need for treating tobacco addiction as a chronic relapsing disorder and to match it with an appropriate and tailored amount of care," the researchers wrote.

The study appeared online in the January 2009 pre-print issue of the European Respiratory Journal.