Diagnosis and treatment outcomes from prebronchodilator spirometry performed alongside lung cancer screening in a Lung Health Check programme

Bradley, Claire; Boland, Alison; Clarke, Louisa; Dallinson, Naomi; Eckert, Claire; Ellames, Deborah; Finn, Jonathan; Gabe, Rhian; Hancock, Neil; Kennedy, Martyn PT; Lindop, Jason; Mohamed, Ayad; Mullen, Gabriel; Murray, Rachael L.; Rogerson, Suzanne; Shinkins, Bethany; Simmonds, Irene; Upperton, Sara; Wilkinson, Anne; Crosbie, Philip A.; Callister, Matthew E.J.

Abstract

Introduction: Incorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described. Methods: Participants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated to the general practitioner (GP), and those with unexplained symptomatic airflow obstruction (AO) fulfilling agreed criteria were referred to the Leeds Community Respiratory Team (CRT) for assessment and treatment. Primary care records were reviewed to determine changes to diagnostic coding and pharmacotherapy. Results: Of 2391 LHC participants undergoing prebronchodilator spirometry, 201 (8.4%) fulfilled the CRT referral criteria of which 151 were invited for further assessment. Ninety seven participants were subsequently reviewed by the CRT, 46 declined assessment and 8 had already been seen by their GP at the time of CRT contact. Overall 70 participants had postbronchodilator spirometry checked, of whom 20 (29%) did not have AO. Considering the whole cohort referred to the CRT (but excluding those without AO postbronchodilation), 59 had a new GP COPD code, 56 commenced new pharmacotherapy and 5 were underwent pulmonary rehabilitation (comprising 2.5%, 2.3% and 0.2% of the 2391 participants undergoing LHC spirometry). Conclusions: Delivering spirometry alongside lung cancer screening may facilitate earlier diagnosis of COPD. However, this study highlights the importance of confirming AO by postbronchodilator spirometry prior to diagnosing and treating patients with COPD and illustrates some downstream challenges in acting on spirometry collected during an LHC.

Citation

Bradley, C., Boland, A., Clarke, L., Dallinson, N., Eckert, C., Ellames, D., …Callister, M. E. (2023). Diagnosis and treatment outcomes from prebronchodilator spirometry performed alongside lung cancer screening in a Lung Health Check programme. Thorax, Article 219683. https://doi.org/10.1136/thorax-2022-219683

• Journal Article Type: Article
• Acceptance Date: Feb 2, 2023
• Online Publication Date: Mar 27, 2023
• Publication Date: Mar 27, 2023
• Deposit Date: Mar 31, 2023
• Publicly Available Date: Apr 6, 2023
• Journal: Thorax
• Print ISSN: 0040-6376
• Electronic ISSN: 1468-3296
• Publisher: BMJ
• Peer Reviewed: Peer Reviewed
• Article Number: 219683
• DOI: https://doi.org/10.1136/thorax-2022-219683
• Public URL: https://nottingham-repository.worktribe.com/output/19009036
• Publisher URL: https://thorax.bmj.com/content/early/2023/03/26/thorax-2022-219683
• Additional Information: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/; This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.