Spirometry and under-diagnosis of COPD in a lung cancer screening cohort

Abstract

<b>Aims:</b> Spirometry has been considered as an adjunct to Lung Cancer Screening (LCS) programmes with the aim of identifying people with previously undiagnosed Chronic Obstructive Pulmonary Disease (COPD). <b>Methods:</b> The Yorkshire Lung Screening Trial is a LCS trial where participants at high-risk for lung cancer are invited to a ‘Lung Health Check’ (LHC) comprising a low-dose CT scan, questionnaires, and spirometry. <b>Results:</b> Between November 2018 and March 2020, 3920 participants underwent spirometry as part of their LHC. Airflow obstruction (AO) was present in&nbsp;1727 (44%), of which 91 self-reported a diagnosis of asthma and were excluded from subsequent analysis. Of the remaining 1636 participants with AO, 676 (41%) had a COPD code recorded in their GP record and 960 (59%) did not. Of these 960 participants with AO but no GP COPD code, 655 had at least one COPD-defining symptom. Interestingly, of the 836 participants with a GP COPD code 160 (19%)&nbsp;had <b>no</b> AO on spirometry measured during their LHC. Characteristics of these participant groups are shown in Figure 1. Comparing participants with undiagnosed symptomatic AO against those with AO and a GP COPD code, the former group were more likely to be male and current smokers but had less severe disease parameters (better spirometry, lower COPD assessment test (CAT) score). <b>Conclusion:</b> In a cohort of ever-smokers attending LCS, approximately&nbsp;half with AO and symptoms had no GP coded diagnosis of COPD.