Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD?MethodsThe single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD.ResultsAmong 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%.ConclusionsCOPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs.Trial registration(Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008)
Highlights
Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer
Among 2537 subjects recruited to the Pan-Canadian Early Detection of Lung Cancer (PanCan) study, 2514 had available spirometry data and were included in the analysis
The primary goal of lowdose computed tomography (LDCT) screening has been to diminish the risk of death from lung cancer
Summary
Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Chronic obstructive pulmonary disease (COPD) and lung cancer are associated diseases, sharing tobacco as a common cause. Screening of asymptomatic individuals for COPD is not currently recommended by the US Preventative Services Task Force as clinical benefit has not been demonstrated in this population [13]. Based largely on the results of the National Lung Screening Trial, lowdose computed tomography (LDCT) screening for lung cancer is recommended by the US Preventative Services Task Force and funded by the Centers for Medicare and Medicaid [14,15,16]. A significant proportion of ever smokers is found to have pulmonary emphysema on their screening low-dose CT scan (LDCT), CT scanning alone is not sufficient to make a diagnosis of COPD [18]. While there is no disease-modifying treatment for smoking-induced COPD, treatment of individuals with moderate or worse COPD with long-acting bronchodilators with or without inhaled corticosteroids has been shown to improve lung function, improve quality of life, and decrease disease exacerbations [19]
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