Lung cancer screening program identifies airways disease in previously undiagnosed COPD
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Key takeaways:
- More individuals with vs. without a history of COPD had pulmonary comorbidities on low-dose CT.
- Age, gender and smoking status significantly differed between these two groups.
SAN DIEGO — More than 75% of individuals who underwent lung cancer screening without a reported history of COPD had airways disease, according to research presented at the American Thoracic Society International Conference.
Airflow obstruction was also apparent in 36.5% of individuals with previously undiagnosed COPD and spirometry data, according to researchers.
“These findings will help the everyday clinician target the most at-risk populations for previously undiagnosed COPD,” Michaela Seigo, DO, chief pulmonary and critical care fellow at Temple Health, told Healio.
Using data from the Temple Healthy Chest Initiative (THCI) lung cancer screening program between October 2021 and October 2022, Seigo and colleagues evaluated 2,083 individuals with low-dose CT scans to determine how individuals with vs. without a history of COPD differ based on demographics and pulmonary comorbidities.
Notably, the THCI also involves symptom detection during the time of the low-dose CT scan, in which patients report their symptoms through a phone call or a paper survey to a dedicated Nurse Navigator.
Researchers divided up patients according to their COPD status noted in the electronic medical record. This record also housed patient demographic information and spirometry data.
Between those with vs. without a history of COPD, researchers observed significant differences in mean age (65.8 years vs. 63.9 years), gender (women, 56.6% vs. 50.2%), smoking status (current, 49.2% vs. 59.6%; former, 50% vs. 35.9%) and the classification of a race other than Black, non-Hispanic; Asian/Native American/Pacific Islander; white, non-Hispanic; Hispanic; and unknown (4.3% vs. 5.6%).
LungRADS scores also differed between the two groups. Compared with individuals with COPD, a greater proportion of individuals without COPD had a score of 1 (37.3% vs. 32.6%) and 3 (8.3% vs. 6.9%). In contrast, the group with vs. without COPD had a higher proportion of individuals with a score of 2 (52.3% vs. 50.2%) and 4 (7.6% vs. 3.8%).
Researchers also found significant differences between the two groups with regard to the prevalence of various pulmonary comorbidities on low-dose CT.
Significantly fewer individuals without vs. with a history of COPD had emphysema (27.5% vs. 72.5%), airways disease (76.2% vs. 84%), emphysema plus airways disease (25.9% vs. 32.3%), bronchiectasis (12% vs. 17.9%) and interstitial lung disease (6.7% vs. 11.3%).
“We detected pulmonary comorbidities at higher rates than previously published,” Seigo said. “I think this is a reflection of how our population at Temple is unique: it is composed of more city-dwelling, lower income and racial/ethnic minorities/people of color.”
Of the total cohort, less than one-third of patients completed a symptom survey (29%) and had spirometry data (30%).
Symptom survey results revealed that those without COPD had a significantly higher proportion of individuals deemed less dyspneic than those with COPD (72% vs. 62.8%) and a significantly lower proportion of individuals with ever dyspnea (88.1% vs. 93.6%).
Additionally, a significantly lower proportion of those without vs. with COPD had “more cough” (27.4% vs. 34.2%) and agreed with the statement, “breathing affects your ability to do things” (24.5% vs. 56.6%), according to researchers.
Airflow obstruction was identified as an FEV1/FVC ratio less than 70% and was observed in 36.5% of those without a history of COPD vs. 69.2% of those with a history of COPD.
When considering how future studies will be different, Seigo highlighted AI.
“In the future, I think AI will play a dominant role,” she said. “At-risk populations will get [low-dose] CT scans and AI will spit out a list of pulmonary and extra-pulmonary comorbidities that may need to be addressed.
“Together, with symptom detection plus strategic and more widely available access to screening in general, there is a huge opportunity to intervene earlier and potentially save lives,” Seigo continued.