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Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD
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 Tr...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
European Respiratory Society
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440649/ https://www.ncbi.nlm.nih.gov/pubmed/37609601 http://dx.doi.org/10.1183/23120541.00203-2023 |
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author | Bradley, Claire Alexandris, Panos Baldwin, David R. Booton, Richard Darby, Mike Eckert, Claire J. Gabe, Rhian Hancock, Neil Janes, Sam Kennedy, Martyn Lindop, Jason Neal, Richard D. Rogerson, Suzanne Shinkins, Bethany Simmonds, Irene Upperton, Sara Vestbo, Jorgen Crosbie, Philip A.J. Callister, Matthew E.J. |
author_facet | Bradley, Claire Alexandris, Panos Baldwin, David R. Booton, Richard Darby, Mike Eckert, Claire J. Gabe, Rhian Hancock, Neil Janes, Sam Kennedy, Martyn Lindop, Jason Neal, Richard D. Rogerson, Suzanne Shinkins, Bethany Simmonds, Irene Upperton, Sara Vestbo, Jorgen Crosbie, Philip A.J. Callister, Matthew E.J. |
author_sort | Bradley, Claire |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10440649 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | European Respiratory Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-104406492023-08-22 Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD Bradley, Claire Alexandris, Panos Baldwin, David R. Booton, Richard Darby, Mike Eckert, Claire J. Gabe, Rhian Hancock, Neil Janes, Sam Kennedy, Martyn Lindop, Jason Neal, Richard D. Rogerson, Suzanne Shinkins, Bethany Simmonds, Irene Upperton, Sara Vestbo, Jorgen Crosbie, Philip A.J. Callister, Matthew E.J. ERJ Open Res Original Research Articles 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. European Respiratory Society 2023-08-21 /pmc/articles/PMC10440649/ /pubmed/37609601 http://dx.doi.org/10.1183/23120541.00203-2023 Text en Copyright ©The authors 2023 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org) |
spellingShingle | Original Research Articles Bradley, Claire Alexandris, Panos Baldwin, David R. Booton, Richard Darby, Mike Eckert, Claire J. Gabe, Rhian Hancock, Neil Janes, Sam Kennedy, Martyn Lindop, Jason Neal, Richard D. Rogerson, Suzanne Shinkins, Bethany Simmonds, Irene Upperton, Sara Vestbo, Jorgen Crosbie, Philip A.J. Callister, Matthew E.J. Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title | Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title_full | Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title_fullStr | Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title_full_unstemmed | Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title_short | Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD |
title_sort | measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of copd |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10440649/ https://www.ncbi.nlm.nih.gov/pubmed/37609601 http://dx.doi.org/10.1183/23120541.00203-2023 |
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