Ruparel, M;
Quaife, SL;
Dickson, JL;
Horst, C;
Tisi, S;
Hall, H;
Taylor, MN;
... Janes, SM; + view all
(2020)
Prevalence, Symptom Burden and Under-Diagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort.
Annals of the American Thoracic Society
, 17
(7)
pp. 869-879.
10.1513/AnnalsATS.201911-857OC.
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Abstract
Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of Chronic Obstructive Pulmonary Disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established. Objectives: To explore associations between symptoms, comorbidities, spirometry and emphysema in participants enrolled in the Lung Screen Uptake Trial (LSUT). Methods: This cross-sectional study was a pre-specified analysis nested within LSUT, which was a randomized study testing the impact of differing invitation materials on attendance of 60-75 year-old smokers and ex-smokers to a ‘lung health check’ between November 2015 and July 2017. Participants with a smoking history ≥30 pack-years and quit ≤15 years ago, or meeting a lung cancer risk of ≥1.51% via the Prostate Lung Colorectal Ovarian (PLCOm2012) model or ≥2.5% via the Liverpool Lung Project (LLP) model, were offered LDCT. COPD was defined and classified according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria using pre-bronchodilator spirometry. Analyses included the use of descriptive statistics, chi square tests to examine group differences, and univariable and multivariable logistic regression to explore associations between symptom prevalence, airflow limitation and visually graded emphysema. Results: 560 of 986 individuals included in the analysis (57%) had pre-bronchodilator spirometry consistent with COPD. 67% did not have a prior history of COPD and were termed ‘undiagnosed’. Emphysema prevalence in those with known and ‘undiagnosed’ COPD was 73% and 68% respectively. 32% of those with ‘undiagnosed COPD’ had no emphysema on LDCT. Inhaler use and symptoms were more common in the ‘known’ than the ‘undiagnosed’ COPD group (63% vs. 33% with persistent cough [p<0.001], 73% vs. 33% with dyspnoea [p<0.001]). Comorbidities were common in all groups. Adjusted odds of respiratory symptoms were more significant for airflow obstruction (aOR GOLD 1&2: 1.57, CI 1.14-2.17; aOR GOLD 3&4: 4.6, CI 2.17-9.77); than emphysema (aOR mild: 1.12, CI 0.81-1.55; aOR moderate: 1.33, CI 0.85-2.09; aOR severe: 4.00, CI 1.57-10.2). Conclusions: There is high burden of ‘undiagnosed COPD’ and emphysema in LCS participants. Adding spirometry findings to the LDCT enhances identification of individuals with COPD. Clinical trial registered with ClinicalTrials.gov (NCT02558101)
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