Lung cancer screening identified that 75% of participants without a prior COPD diagnosis met objective criteria for COPD, and the overall incidence of PRISm was 37.1%.
Observational (n=310)
No
Lung cancer screening programs can identify a high prevalence of unrecognized COPD and PRISm, particularly in diverse populations, offering opportunities for early risk modification.
Abstract Background Lung cancer screening (LCS) programs offer a unique platform to study chronic obstructive pulmonary disease (COPD) given the overlapping risk factors of smoking and exposure history. LCS cohorts therefore enable characterization of subclinical or unrecognized disease before overt clinical presentation, along with increased identification of systemic comorbidities, beyond the presence of lung cancer on low dose computed tomography (LDCT). Methods Participants attending Temple Healthy Chest Initiative LCS consented to participate in an observational study. Data was collected from electronic medical record (EMR) and participant questionnaires including demographics, body mass index (BMI), medical history, medications, blood eosinophil count (BEC) and smoking/occupational exposure. Pre-bronchodilator spirometry, fractional exhaled nitric oxide (FeNO), BEC where unavailable from EMR and symptoms using Chronic Airways Assessment Test CAAT were collected on the day of LDCT (quantitative image analysis: Coreline AVIEW COPD). Results Of 310 participants, 187 (60.2%) were female, mean age 63.2; A total of 232 (74.8%) participants identified as Black/African American. Further baseline characteristics are shown in Table 1. Among 164 individuals without a recorded COPD diagnosis, 123 (75%) met at least one objective criterion suggestive of COPD: obstructive lung function (FEV1/FVC0.7), reduced FEV1 percent predicted (FEV1pp) or evidence of emphysema on LDCT as defined by percent low attenuation area (%LAA-950) ≥5%, of whom 97/123 (78.9%) were Black/African American. Current smoking status was more prevalent in males and those of Black/African American or Hispanic origin. The mean FEV1 was 1.8 L/min (SD 0.7); FEV1pp was lowest in Black/African American participants (67.01% vs 76.27%; p = 0.0005). The mean CAT score for the cohort was 19.5 (SD 8.6), with higher values in women compared to men (20.29 vs 18.21; p-value: 0.0384). Mean BMI was 31.2 (SD 8.2). The incidence of Preserved Ratio Impaired Spirometry (PRISm), defined as FEV1pp 80% and FEV1/FVC ≥0.7, was 37.1% and was associated with a higher BMI (33.3 SD 7.9). Mean FEV1 and CAT scores for those with PRISm were comparable to the overall cohort. Conclusions This cohort underscores the utility of LCS programs for COPD diagnosis, phenotyping and risk stratification in a racially and ethnically diverse population. We observed a higher incidence of unrecognized and/or undertreated COPD among Black African American individuals and women, accompanied by more severe lung function impairment and higher symptom burden. We found a high prevalence of PRISm, known to represent increased cardiometabolic risk, relative to other published COPD cohorts. These findings have important implications for opportunistic risk modification. This abstract is funded by: AstraZeneca
Vegas-Sanchez-Ferrero et al. (Fri,) conducted a observational in COPD and PRISm (n=310). Lung cancer screening was evaluated on Objective criteria suggestive of COPD in participants without a recorded diagnosis. Lung cancer screening identified that 75% of participants without a prior COPD diagnosis met objective criteria for COPD, and the overall incidence of PRISm was 37.1%.
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