What question did this study set out to answer?

This study aims to identify predictors of abnormal spirometry among individuals receiving lung cancer screening who are at risk for COPD.

May 20, 2026

A31-16 Predictors of COPD and PRISm Among Patients Undergoing Lung Cancer Screening: A Prospective Cohort Study

Key Points

This study aims to identify predictors of abnormal spirometry among individuals receiving lung cancer screening who are at risk for COPD.
Conducted a prospective cohort analysis with 112 participants undergoing lung cancer screening.
Evaluated spirometry results and collected clinical data from electronic health records.
Performed multivariate logistic regression to identify associations between characteristics and abnormal spirometry.
Over 60% of participants exhibited abnormal spirometry results.
Significant predictors of abnormal spirometry included age, smoking intensity, and comorbidities.
Patients with abnormal spirometry reported higher symptom burden on the COPD Assessment Test (p = 0.04).

Abstract

Abstract Rationale Half of individuals receiving lung cancer screening (LCS) may have chronic obstructive pulmonary disease (COPD) with airflow obstruction on spirometry. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends targeted spirometry during LCS. To identify characteristics associated with abnormal spirometry, we carried out an interim data analysis of a prospective cohort study that aims to elucidate COPD and screening outcomes among individuals receiving LCS. Methods Eligible participants were identified through a centralized LCS Program and underwent informed consent at an in-person LCS appointment. Inclusion criteria included LCS eligibility by US Preventive Services Task Force 2021 recommendations and possible COPD defined as ≥ 1 of the following: 1) COPD diagnosis in the electronic health record (EHR), 2) previous spirometry with post-bronchodilator FEV1/FVC≤0.7, or 3) LDCT-reported emphysema. All patients completed standardized symptom questionnaires and post-bronchodilator spirometry (or historical spirometry within 12 months). Additional clinical data were extracted from the EHR and the LCS Registry. Descriptive statistics and multivariate logistic regression were performed. The Thomas Jefferson University IRB approved this cohort study (iRISID-2024-1246); additional details are on clinicaltrials.gov (NCT06974981). Results A total of 112 patients were enrolled and completed spirometry or had historical spirometry. The study cohort was comprised of 65% women and 46% White and 46% Black patients. Among the 57 patients with airflow obstruction, most had GOLD I (44.7%) or GOLD II (49.1%) COPD. Overall, 56.1% of participants had a COPD Assessment Test (CAT)≥10, with the highest proportion of these patients in GOLD II/III categories. Similarly, Modified Medical Research Council (mMRC) dyspnea score≥2 was most frequent among GOLD II/III patients. Upon comparing study participants with normal spirometry (n = 44) vs. those with Preserved Ratio Impaired Spirometry (PRISm) or GOLD I-III (n = 68), there were statistically significant differences in mean age and insurance status but no difference in gender, race, smoking status, or pack-years between the two groups. Patients with abnormal spirometry more frequently reported high symptom burden with CAT≥10 (p = 0.04), but there was no difference in mMRC or CAPTURE scores. On multivariate logistic regression, age, smoking intensity, and comorbidities were significantly associated with abnormal spirometry (Table). Conclusion In this interim analysis of USPSTF-eligible LCS participants at risk for COPD, we found that over 60% have abnormal spirometry and that baseline characteristics were predictive of spirometry results. Investigating COPD among LCS participants presents a novel opportunity to develop and evaluate strategies for COPD detection and management, as well as for patient selection for LCS. This abstract is funded by: Astra Zeneca UK

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