Predicting the response to a bronchodilator in patients with airflow obstruction and lung cancer

BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.Results99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV1/FVC ratio (<0.0001) and being asymptomatic (adjOR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (adjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).ConclusionsIncorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.

Download Full-text

The Partners—Airflow Obstruction, Emphysema, and Lung Cancer

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.200806-902ed ◽

2008 ◽

Vol 178 (7) ◽

pp. 665-666 ◽

Cited By ~ 4

Author(s):

Steven M. Dubinett ◽

Denise R. Aberle ◽

Donald P. Tashkin ◽

Jenny T. Mao

Keyword(s):

Lung Cancer ◽

Airflow Obstruction

Download Full-text

Are patients with airflow obstruction and emphysema at a higher risk of developing lung cancer?

Respiratory Medicine COPD Update ◽

10.1016/j.rmedu.2009.02.006 ◽

2009 ◽

Vol 5 (1) ◽

pp. 28

Keyword(s):

Lung Cancer ◽

Airflow Obstruction

Download Full-text

Lung Cancer Detection in Patients With Airflow Obstruction Identified in a Primary Care Outpatient Practice*

CHEST Journal ◽

10.1378/chest.127.4.1140 ◽

2005 ◽

Vol 127 (4) ◽

pp. 1140 ◽

Cited By ~ 8

Author(s):

Joel J. Bechtel

Keyword(s):

Lung Cancer ◽

Primary Care ◽

Cancer Detection ◽

Airflow Obstruction ◽

Outpatient Practice ◽

Lung Cancer Detection

Download Full-text

Are Airflow Obstruction and Radiographic Evidence of Emphysema Risk Factors for Lung Cancer?

CHEST Journal ◽

10.1378/chest.09-2567 ◽

2010 ◽

Vol 138 (6) ◽

pp. 1295-1302 ◽

Cited By ~ 56

Author(s):

Fabien Maldonado ◽

Brian J. Bartholmai ◽

Stephen J. Swensen ◽

David E. Midthun ◽

Paul A. Decker ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Airflow Obstruction ◽

Radiographic Evidence

Download Full-text

Quality Improvement Initiatives to Optimize the Management of Chronic Obstructive Pulmonary Disease in Patients With Lung Cancer

Journal of Oncology Practice ◽

10.1200/jop.2017.022228 ◽

2017 ◽

Vol 13 (11) ◽

pp. e957-e965

Author(s):

Geneviève C. Digby ◽

Andrew Robinson

Keyword(s):

Lung Cancer ◽

Chronic Obstructive Pulmonary Disease ◽

Quality Improvement ◽

Pulmonary Disease ◽

Airflow Obstruction ◽

Diagnostic Assessment ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Assessment Program ◽

Over Time

Purpose: Patients with lung cancer (LC) frequently have chronic obstructive pulmonary disease (COPD), the optimization of which improves outcomes. A 2014 Queen’s University Hospitals audit demonstrated that COPD was underdiagnosed and undertreated in outpatients with LC. We sought to improve the diagnosis and management of COPD in this population. Methods: We implemented change using a Define/Measure/Analyze/Improve/Control (DMAIC) improvement cycle. Data were obtained by chart review from the Cancer Care Ontario database and e-Patient System for patients with newly diagnosed LC, including patient characteristics, pulmonary function test (PFT) data, and bronchodilator therapies. Improvement cycle 1 included engaging stakeholders and prioritizing COPD management by respirologists in the Lung Diagnostic Assessment Program. Improvement cycle 2 included physician restructuring and developing a standard work protocol. Data were analyzed monthly and presented on statistical process control P-charts, which assessed differences over time. The χ2 and McNemar tests assessed for significance between independent and dependent groups, respectively. Results: A total of 477 patients were studied (165 patients at baseline, 166 patients in cycle 1, and 127 patients in cycle 2). There was no change in PFT completion over time, although respirology-managed patients were significantly more likely to undergo a PFT than patients who were not managed by respirology (56.7% v 96.1%; P < .00001). The proportion of respirology-managed patients with LC with airflow obstruction receiving inhaled bronchodilator significantly increased (baseline, 46.3%; cycle 1, 51.0%; and cycle 2, 74.3%). By cycle 2, patients with airflow obstruction were more likely to receive a long-acting bronchodilator if managed by respirology (74.3% v 44.8%; P = .0009). Conclusion: COPD is underdiagnosed and undertreated in outpatients with LC. A DMAIC quality improvement strategy emphasizing COPD treatment during LC evaluation in the Lung Diagnostic Assessment Program significantly improved COPD management.

Download Full-text

Faculty Opinions recommendation of Association of radiographic emphysema and airflow obstruction with lung cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1123226.580366 ◽

2008 ◽

Author(s):

Patrick Nana-Sinkam ◽

Shiva Rahmanian

Keyword(s):

Lung Cancer ◽

Airflow Obstruction

Download Full-text

Chromosomal aneusomy in sputum predicts for lung cancer in nested case-control study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7201 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7201-7201

Author(s):

W. Franklin ◽

A. P. Schulte ◽

C. Zeng ◽

H. J. Wolf ◽

X. Yin ◽

...

Keyword(s):

Lung Cancer ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Airflow Obstruction ◽

Disease Diagnosis ◽

Case Control ◽

Sample Collection ◽

Nested Case Control ◽

Heavy Smokers

7201 Background: Lung cancer usually is disseminated at diagnosis and prognosis is poor for most patients. Heavy smokers are known to be at high risk factor for lung cancer and are target population for lung cancer prevention. Sputum has long been considered a potential source of material for biomarker based early detection but no tests have been validated. Methods: Chromosome aneusomy was sought in sputum of 114 cases and 110 controls from the Colorado Sputum Screening Cohort Study, which includes heavy smokers with airflow obstruction matched on age, gender, and date of sample collection. Subject characteristics were as follows: mean age 67 (± 8 years), 75% males, 36% current smokers, mean pack-year 71.2 (± 33.5). The FISH probe LAVysion (Vysis/Abbott) was used, including the DNA targets EGFR, MYCC, 5p15 and CEP6. Results: The multi-target set showed the highest sensitivity (0.78) and specificity (0.95) rates in specimens collected within 12 months of lung cancer diagnosis. The individual probes EGFR, MYCC, 5p15 and CEP6 showed, respectively, decreasing sensitivity rates (0.78, 0.67, 0.62, and 0.29) and increasing specificity rates (0.84, 0.91. 0.86, and 0.95). Combinations of two specific probes (AND) or of any of two probes (OR) have not favorably impacted these coefficients. Proportion of abnormal sputum specimens was higher in squamous cell carcinoma than in adenocarcinoma or small cell carcinoma, both considering the set of specimens collected 12 months prior to disease diagnosis (92%, 75%, 60%) and all specimens (80%, 58%, 44%). Conclusions: Chromosomal aneusomy in sputum was demonstrated in a nested case-control cohort to be a promising marker for prediction of lung cancer risk in heavy smokers with airflow obstruction. Evaluation of four DNA targets was more effective than any single marker or combination of markers, and the test had high sensitivity in patients with squamous cell carcinoma. [Table: see text]

Download Full-text