Lung cancer screening with low-dose computed tomography (LDCT) can effectively screen a population at high risk for undiagnosed chronic obstructive pulmonary disease (COPD) and airflow obstruction, according to data from a new study of approximately 2,000 individuals.
Previous research shows that about 70% to 90% of people with chronic obstructive pulmonary disease are undiagnosed, especially low-income populations and minorities who may be less likely to get screened, explained Dr. Michaela A. Seigo. , from Temple University Hospital, Philadelphia, United States, in a study presented at the International Congress of the American Thoracic Society (ATS) 2024. Although current guidelines from the United States Preventive Services Commission (USPSTF) advise against universal screening of chronic obstructive pulmonary disease in asymptomatic adults, the use of low-dose computed tomography may be an option to evaluate a high-risk population, the researchers said.
The research team reviewed data from 2,083 adults enrolled in the Temple Healthy Chest Initiative, a lung cancer screening program implemented throughout the urban health system, combined with screening for symptoms and comorbidities.
Baseline Low Dose Computed Tomography for Identification of Comorbidities
Study participants underwent baseline low-dose CT scans between October 2021 and October 2022. Images were reviewed by radiologists for pulmonary comorbidities, including emphysema, airway diseases, bronchiectasis, and interstitial lung disease. . Additionally, 604 participants (29%) completed a symptom survey and 624 (30%) underwent spirometry. The average age of the people was 65.8 years and 63.9 years for those with and without a history of chronic obstructive pulmonary disease, respectively.
Approximately half of the participants in both groups were women.
Overall, 66 of 181 (36.5%) people with previously undiagnosed chronic obstructive pulmonary disease had spirometric data consistent with airflow obstruction (forced expiratory volume in the first second and forced vital capacity, <70%). Individuals with previously undiagnosed chronic obstructive pulmonary disease were more likely to be younger, male, current smokers, and identify as Hispanic American or another race (not black, white, Hispanic American, or Asian/Native American/Pacific Islander). .
People without a reported history of chronic obstructive pulmonary disease had fewer pulmonary comorbidities on low-dose computed tomography and lower rates of respiratory symptoms than those with chronic obstructive pulmonary disease. However, almost 25% of people without a reported history of the disease said that breathing problems affected their “ability to do activities,” Dr. Seigo said, and the majority of people without a diagnosis of chronic obstructive pulmonary disease had chronic obstructive pulmonary disease. of the airways (76.2% versus 84% of patients diagnosed with chronic obstructive pulmonary disease). Furthermore, 88.1% of the participants declared having ever experienced dyspnea and 72.6% cough; Both symptoms are compatible with a clinical diagnosis of chronic obstructive pulmonary disease, the team of researchers noted.
“We detected pulmonary comorbidities at higher rates than previously published,” Dr. Seigo stated in an interview. The increase likely reflects Temple’s patient population, which includes a relatively high percentage of city dwellers, low-income people, as well as more racial and ethnic minorities and people of color, she listed.
However, “these findings will help clinicians focus on populations at highest risk for previously undiagnosed chronic obstructive pulmonary disease,” Dr. Seigo noted.
Dr. Seigo believes that in the future, artificial intelligence (AI) will play a leading role in screening for chronic obstructive pulmonary disease. “At-risk populations will undergo low-dose CT scans, and artificial intelligence will identify pulmonary and extrapulmonary comorbidities that may need to be addressed,” she said.
Combining symptom detection with strategic, more widespread access to screening offers “a great opportunity to intervene earlier and save lives,” he told Medscape Medical News.
Lung cancer screening could lead to earlier intervention in chronic obstructive pulmonary disease
The present study examines the prevalence of undiagnosed chronic obstructive pulmonary disease, especially in low-income and minority populations, in an asymptomatic high-risk group. “By integrating CT lung cancer screening with screening for lung comorbidities on low-dose CT and respiratory symptoms, the current study aimed to identify individuals with undiagnosed chronic obstructive pulmonary disease,” he said in an interview. Dr. Dharani K. Narendra, from Baylor College of Medicine in Houston, United States.
“The study highlighted the feasibility and potential benefits of coupling lung cancer screening with detection of chronic obstructive pulmonary disease, which is noteworthy, and hits two targets with a single arrow ─the early detection of lung cancer and chronic obstructive pulmonary disease─ in high-risk groups,” said Dr. Narendra.
“Although the US Preventive Services Commission (USPSTF) advises against screening for chronic obstructive pulmonary disease in asymptomatic patients, abnormal pulmonary comorbidities seen on chest CT scans could serve as a gateway for physicians to perform screening. screening for chronic obstructive pulmonary disease,” Dr. Narendra said. “This approach allows for early diagnosis, smoking cessation education, and timely treatment of chronic obstructive pulmonary disease, potentially preventing deterioration in lung function and reducing the risk of exacerbations,” she stressed.
The finding that one-third of previously undiagnosed, asymptomatic chronic obstructive pulmonary disease patients showed significant rates of airflow obstruction on spirometry is consistent with previous research, Dr. Narendra shared with Medscape Medical News.
“Interestingly, in the questions about specific symptoms, patients with undiagnosed chronic obstructive pulmonary disease reported higher rates of dyspnea, more cough, and breathing difficulties that affected their daily activities (16.1%, 27.4% and 24%). .5%, respectively), which shows a lower perception of symptoms,” he noted.
“Obstacles to lung cancer screening in high-risk urban communities include limited access to health care facilities, insufficient knowledge of screening programs, economic limitations, and cultural or linguistic barriers,” added Dr. .Narendra.
Possible strategies to overcome these barriers include improving access through additional screening centers and providing transportation, implementing community education and outreach programs to raise awareness about the benefits of lung cancer screening, and timely detection of chronic obstructive pulmonary disease, and the provision of financial assistance through free screening options and collaboration with insurers to cover screening costs, he said.
“Care providers must recognize the dual benefits of lung cancer screening programs, including the opportunity to detect undiagnosed chronic obstructive pulmonary disease,” Dr. Narendra stressed. “This integrated approach is crucial to identifying high-risk individuals who could benefit from early intervention and effective treatment for this disease. Clinicians should actively support the implementation of comprehensive screening programs that incorporate assessment of pulmonary comorbidities using CT. low-dose computerized screening and chronic obstructive pulmonary disease symptom screening questionnaires,” he stressed.
“Further research is needed to evaluate long-term mortality outcomes and identify best practices to determine the most effective methods and cost-effectiveness of implementing and maintaining combined screening programs in diverse urban settings,” said Dr. Narendra. to Medscape Medical News.
He added that other areas that need to be addressed in future studies are investigating specific barriers to screening in different high-risk groups and tailoring interventions to improve screening acceptance and compliance. “By addressing these research gaps, health care professionals can optimize screening programs and improve the overall health of high-risk urban populations,” she concluded.
The study did not receive external funding. The researchers have declared that they have no relevant financial conflicts of interest.
This content was originally published in the English edition of Medscape.