Tisi, Sophie;
Dickson, Jennifer L;
Horst, Carolyn;
Quaife, Samantha L;
Hall, Helen;
Verghese, Priyam;
Gyertson, Kylie;
... SUMMIT Consortium; + view all
(2022)
Detection of COPD in the SUMMIT Study Lung Cancer Screening Cohort using Symptoms and Spirometry.
European Respiratory Journal
, 60
(6)
, Article 2200795. 10.1183/13993003.00795-2022.
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Abstract
BACKGROUND: COPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung cancer risk of individuals with symptomatic undiagnosed COPD in a LCS cohort. METHODS: 16 010 current or former smokers aged 55-77 attended a Lung Health Check as part of the SUMMIT Study [NCT03934866]. A respiratory consultation and spirometry were performed alongside LCS eligibility assessment. Those with symptoms, no previous COPD diagnosis and airflow obstruction were labelled as undiagnosed COPD. Baseline low-dose CT was performed in those at high risk of lung cancer (PLCOm2012 score >1.3% and/or meeting USPSTF 2013 criteria). RESULTS: One in five (19.7%) met criteria for undiagnosed COPD. Compared to those previously diagnosed, those undiagnosed were more likely to be male (59.1% versus 53.2%, p<0.001), currently smoking (54.9% versus 47.6%, p<0.001) and from an ethnic minority group (p<0.001). Undiagnosed COPD was associated with less FEV1 impairment (GOLD grades 1&2 85.3% versus 68.4%, p<0.001) and lower symptom/exacerbation burden (GOLD A&B groups 95.6% versus 77.9%, p<0.001) than those with known COPD. Multivariate analysis demonstrated that airflow obstruction was an independent risk factor for lung cancer risk on baseline LDCT (adjOR 2.74, 95% CI 1.73-4.34; p<0.001), with a high risk seen in those with undiagnosed COPD (adjOR 2.79, 95% CI 1.67-4.64, p<0.001). CONCLUSIONS: Targeted case-finding within LCS detects high rates of undiagnosed symptomatic COPD in those most at risk. Individuals with undiagnosed COPD are at high risk for lung cancer.
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