RT Journal Article
SR Electronic
T1 Detection of COPD in the SUMMIT Study Lung Cancer Screening Cohort using Symptoms and Spirometry
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2200795
DO 10.1183/13993003.00795-2022
A1 Tisi, Sophie
A1 Dickson, Jennifer L.
A1 Horst, Carolyn
A1 Quaife, Samantha L.
A1 Hall, Helen
A1 Verghese, Priyam
A1 Gyertson, Kylie
A1 Bowyer, Vicky
A1 Levermore, Claire
A1 Mullin, Anne-Marie
A1 Teague, Jonathan
A1 Farrelly, Laura
A1 Nair, Arjun
A1 Devaraj, Anand
A1 Hackshaw, Allan
A1 Hurst, John R.
A1 Janes, Sam M.
A1 ,
YR 2022
UL http://erj.ersjournals.com/content/early/2022/06/21/13993003.00795-2022.abstract
AB 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of Interests: Sophie Tisi, Jennifer L. Dickson, Carolyn Horst, Helen Hall and Priyam Verghese are all funded or part-funded through GRAIL Inc as part of the SUMMIT Study.Conflict of Interests: Sam M. Janes was a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA). Sam M. Janes is supported by CRUK programme grant EDDCPGM\100002, the Rosetrees Trust, the Roy Castle Lung Cancer foundation, the Garfield Weston Trust and UCLH Charitable Foundation. Sam M. Jane's full disclosures are as a Paid Advisory Board member Astra-Zeneca, Bard1 Bioscience, Achilles Therapeutics, Jansen. Assistance for travel to meetings from Astra Zeneca, Takeda, and grant income from GRAIL Inc, Owlstone and share options from Optellum; BARD1 Lifescience Ltd.Conflict of Interests: Samantha L Quaife is supported by a Cancer Research UK (CRUK) Population Research Fellowship (C50664/A24460) and Barts Charity (MRC&U0036).Conflict of Interests: Arjun Nair is part-funded through the UCLH Biomedical Research Centre.Conflict of Interests: Anand Devaraj's disclosures are personal fees from Boehringer Ingelheim, Roche, Galacto Biotech, Galapagos and Vicore.Conflict of Interests: Allan Hackshaw's disclosures are consulting fees to Evidera Inc and assistance for travel to meetings from GRAIL Inc.Conflict of Interests: John R Hurst's disclosures are assistance for travel from Astra Zeneca and Boehringer Ingelheim and payment for lectures and presentations from Astra Zeneca, Boehringer Ingelheim, Nutricia and Takeda.There are no disclosures from Kylie Gyertson, Vicky Bowyer, Claire Levermore, Anne-Marie Mullin, Jonathan Teague and Laura Farrelly