Department of Respiratory Medicine, Belfast Health and Social Care Trust, Belfast, UK.
Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Thorax. 2023 Jun;78(6):543-550. doi: 10.1136/thorax-2022-219683. Epub 2023 Mar 27.
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.
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.
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).
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.
将肺量计检查纳入低剂量 CT（LDCT）筛查肺癌中可能有助于发现未确诊的慢性阻塞性肺疾病（COPD）患者，尽管其下游影响尚未得到很好的描述。
参加作为约克郡肺癌筛查试验一部分的肺部健康检查（LHC）的参与者除了 LDCT 筛查外，还接受肺量计检查。结果被通知给全科医生（GP），并且那些符合既定标准的、有不明原因的症状性气流阻塞（AO）的人被转介到利兹社区呼吸团队（CRT）进行评估和治疗。审查初级保健记录以确定诊断编码和药物治疗的变化。
在 2391 名接受支气管扩张剂前肺量计检查的 LHC 参与者中，有 201 名（8.4%）符合 CRT 转诊标准，其中 151 名受邀进一步评估。97 名参与者随后由 CRT 进行了评估，46 名拒绝了评估，8 名在 CRT 联系时已经由他们的 GP 进行了评估。共有 70 名参与者接受了支气管扩张剂后肺量计检查，其中 20 名（29%）没有 AO。考虑到所有转介到 CRT 的患者（但不包括支气管扩张后没有 AO 的患者），有 59 名患者的 GP COPD 代码发生了变化，56 名患者开始了新的药物治疗，5 名患者接受了肺康复治疗（占接受 LHC 肺量计检查的 2391 名参与者的 2.5%、2.3%和 0.2%）。
在肺癌筛查中同时提供肺量计检查可能有助于更早诊断 COPD。然而，本研究强调了在诊断和治疗 COPD 患者之前通过支气管扩张剂后肺量计检查来确认 AO 的重要性，并说明了在 LHC 中收集的肺量计检查的一些下游挑战。
