Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD

Claire Bradley; Panos Alexandris; David R Baldwin; Richard Booton; Mike Darby; Claire J Eckert; Rhian Gabe; Neil Hancock; Sam Janes; Martyn Kennedy; Jason Lindop; Richard D Neal; Suzanne Rogerson; Bethany Shinkins; Irene Simmonds; Sara Upperton; Jorgen Vestbo; Philip A J Crosbie; Matthew E J Callister

doi:10.1183/23120541.00203-2023

Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD

ERJ Open Res. 2023 Aug 21;9(4):00203-2023. doi: 10.1183/23120541.00203-2023. eCollection 2023 Jul.

Authors

Claire Bradley¹, Panos Alexandris², David R Baldwin³, Richard Booton⁴, Mike Darby⁵, Claire J Eckert⁶, Rhian Gabe², Neil Hancock⁶, Sam Janes⁷, Martyn Kennedy⁸, Jason Lindop⁹, Richard D Neal¹⁰, Suzanne Rogerson⁹, Bethany Shinkins⁶, Irene Simmonds⁶, Sara Upperton⁸, Jorgen Vestbo¹¹, Philip A J Crosbie¹¹, Matthew E J Callister⁸

Affiliations

¹ Department Respiratory Medicine, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK.
² Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
³ Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK.
⁴ Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK.
⁵ Department of Radiology, Leeds Teaching Hospitals, Leeds, UK.
⁶ Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK.
⁷ Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
⁸ Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK.
⁹ Department of Research and Innovation, Leeds Teaching Hospitals, Leeds, UK.
¹⁰ College of Medicine and Health, University of Exeter, Exeter, UK.
¹¹ Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK.

Abstract

Introduction: COPD is underdiagnosed, and measurement of spirometry alongside low-dose computed tomography (LDCT) screening for lung cancer is one strategy to increase earlier diagnosis of this disease.

Methods: Ever-smokers at high risk of lung cancer were invited to the Yorkshire Lung Screening Trial for a lung health check (LHC) comprising LDCT screening, pre-bronchodilator spirometry and a smoking cessation service. In this cross-sectional study we present data on participant demographics, respiratory symptoms, lung function, emphysema on imaging and both self-reported and primary care diagnoses of COPD. Multivariable logistic regression analysis identified factors associated with possible underdiagnosis and misdiagnosis of COPD in this population, with airflow obstruction defined as forced expiratory volume in 1 s/forced vital capacity ratio <0.70.

Results: Out of 3920 LHC attendees undergoing spirometry, 17% had undiagnosed airflow obstruction with respiratory symptoms, representing potentially undiagnosed COPD. Compared to those with a primary care COPD code, this population had milder symptoms, better lung function and were more likely to be current smokers (p≤0.001 for all comparisons). Out of 836 attendees with a primary care COPD code who underwent spirometry, 19% did not have airflow obstruction, potentially representing misdiagnosed COPD, although symptom burden was high.

Discussion: Spirometry offered alongside LDCT screening can potentially identify cases of undiagnosed and misdiagnosed COPD. Future research should assess the downstream impact of these findings to determine whether any meaningful changes to treatment and outcomes occur, and to assess the impact on co-delivering spirometry on other parameters of LDCT screening performance such as participation and adherence. Additionally, work is needed to better understand the aetiology of respiratory symptoms in those with misdiagnosed COPD, to ensure that this highly symptomatic group receive evidence-based interventions.