Screening project picks up high numbers of undiagnosed COPD

A project to pick up undiagnosed COPD in people who had attended lung health checks found 70% of those offered an assessment had the condition.

Those involved in the scheme said the findings suggest the NHS Lung Health Check programme provides a targeted opportunity to pick up many more cases of COPD in those at high risk.

Presenting the results of the project at the European Respiratory Society congress, the team said the diagnosis rate was higher than expected and highlighted the impact of a lack of respiratory diagnostic services.

The FRONTIER project set up in Hull is ongoing and plans to test 1,000 patients who were identified during lung cancer screening to have symptoms of lung disease and/or emphysema on CT scan by next year.

It is a one stop shop where those diagnosed get an assessment and treatment plan by a specialist respiratory team which also takes pressure off primary care where provision to spirometry can be patchy, the study lead said.

An interim analysis of the first 201 participants between October 2023 and January 2024 who were invited to additional COPD testing showed that the 136 (68%) were given a new diagnosis of COPD.

The collaboration between Hull University Teaching Hospitals NHS Trust and pharmaceutical company Chiesi, found 77% had moderate emphysema, 12% had mild, 7% had none and 4% had severe disease.

The mean COPD assessment test (CAT) score was 16.7, the team told conference delegates.

Spirometry – the standard of care used to diagnose COPD – was previously included in Lung Health Checks but was stopped during the Covid-19 pandemic, Professor Michael Crooks, professor of respiratory medicine at Hull York Medical School told Pulse.

Yet the data suggests that NHS screening programme could provide a ‘valuable opportunity’ to identify people living with undiagnosed COPD and improve access to diagnostic testing, the team concluded.

It has been estimated that two million people in the UK have undiagnosed COPD.

Repeated concerns have been raised about GP access to respiratory testing due to lack of funding. In May Norfolk LMC warned hospitals were regularly rejecting GP referrals for spirometry.

Asthma+Lung UK has also called for the Government to provide long-term funding for GP practices to offer testing for lung conditions, including spirometry and fractional exhaled nitric oxide (FeNO).

 ‘Our early findings clearly highlight the burden of undiagnosed COPD among those attending the Lung Health Check programme in Hull,’ said Professor Michael Crooks, professor of respiratory medicine at Hull York Medical School. 

He added that many of those they diagnosed through the project were living with daily symptoms and had been able to benefit from treatment.

‘Identifying people attending Lung Health Checks that are at high risk of having undiagnosed COPD and offering diagnostic testing enables access to evidence-based COPD care that has potential to significantly improve health outcomes.’

He added: ‘We were expecting a reasonably high prevalence of undiagnosed COPD. We did invite those who had more severe emphysema early in the programme so we do expect as it progresses for that figure to come down a bit and be closer to 50%.’

The team will also be doing a 12-month follow up to assess the impact of diagnosis and treatment on the patients.

Shish Patel, Medical Director, Chiesi UK & Ireland said the interim findings showed how a lack of COPD screening was playing out in the real world.

‘With challenges in diagnosing COPD including lack of public awareness and engagement with healthcare professionals trained in respiratory diagnostics as well as common misdiagnoses, the value of screening for COPD is clear,’ he added.