Introduction:
Chronic Obstructive Pulmonary Disease (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 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 (AO)
defined as FEV1/FVC ratio <0.70. //
Results:
Of 3,920 LHC attendees undergoing spirometry, 17% had undiagnosed AO 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). Of 836 attendees with a primary care COPD code
who underwent spirometry, 19% did not have AO, 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 if any meaningful changes to treatment and outcomes occurs, and also 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 this highly symptomatic group
receive evidence-based interventions
