Prospective COPD Case Finding in a Lung Cancer Screening Program: A Pilot Study.

Area of Science:

• Pulmonology
• Radiology
• Screening Programs

Background:

• Chronic Obstructive Pulmonary Disease (COPD) is often underdiagnosed and undertreated.
• Current screening for asymptomatic individuals is not recommended, necessitating effective case-finding tools.
• Previous COPD case-finding tools like the CAPTURE questionnaire and peak expiratory flow rate (PEFR) showed disappointing results in primary care.

Purpose of the Study:

• To evaluate the effectiveness of the CAPTURE tool for COPD case-finding within a lung cancer screening (CTLS) program.
• To assess if combining the CAPTURE questionnaire with CT-based emphysema detection can improve COPD diagnosis.
• To compare the diagnostic performance of the CAPTURE tool alone and in combination with PEFR or CT findings.

Main Methods:

• Sixty-seven patients referred to a CTLS program were recruited.
• Participants completed the CAPTURE questionnaire and COPD Assessment Test (CAT).
• Spirometry and low-dose chest CT were performed for all participants.

Main Results:

• Twenty-seven percent of participants had COPD, with significantly higher CAT scores compared to the non-obstructed group.
• The combination of the CAPTURE questionnaire and PEFR demonstrated the highest diagnostic accuracy (AUROC=0.784).
• Combining the CAPTURE questionnaire with CT-identified emphysema also showed high diagnostic accuracy (AUROC=0.779), outperforming the questionnaire alone (AUROC=0.669).

Conclusions:

• The CAPTURE tool is effective for identifying COPD cases within a lung cancer screening setting.
• CT-based diagnosis of emphysema can serve as a substitute for PEFR measurements when using the CAPTURE tool in this population.
• This approach offers a promising strategy to improve COPD detection in high-risk individuals undergoing lung cancer screening.