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IntroductionIncorporating spirometry into low-dose CT (LDCT) screening for lung cancer may help identify people with undiagnosed chronic obstructive pulmonary disease (COPD), although the downstream impacts are not well described.MethodsParticipants attending a Lung Health Check (LHC) as part of the Yorkshire Lung Screening Trial were offered spirometry alongside LDCT screening. Results were communicated to the general practitioner (GP), and those with unexplained symptomatic airflow obstruction (AO) fulfilling agreed criteria were referred to the Leeds Community Respiratory Team (CRT) for assessment and treatment. Primary care records were reviewed to determine changes to diagnostic coding and pharmacotherapy.ResultsOf 2391 LHC participants undergoing prebronchodilator spirometry, 201 (8.4%) fulfilled the CRT referral criteria of which 151 were invited for further assessment. Ninety seven participants were subsequently reviewed by the CRT, 46 declined assessment and 8 had already been seen by their GP at the time of CRT contact. Overall 70 participants had postbronchodilator spirometry checked, of whom 20 (29%) did not have AO. Considering the whole cohort referred to the CRT (but excluding those without AO postbronchodilation), 59 had a new GP COPD code, 56 commenced new pharmacotherapy and 5 were underwent pulmonary rehabilitation (comprising 2.5%, 2.3% and 0.2% of the 2391 participants undergoing LHC spirometry).ConclusionsDelivering spirometry alongside lung cancer screening may facilitate earlier diagnosis of COPD. However, this study highlights the importance of confirming AO by postbronchodilator spirometry prior to diagnosing and treating patients with COPD and illustrates some downstream challenges in acting on spirometry collected during an LHC.

BackgroundScreening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening.MethodsIndividuals aged 55–80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner.ResultsOf 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42–0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54–0.62 for the mostversusthe least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62–0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62–0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees.ConclusionsTelephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.

Introduction and Objectives: Repeat chest x-rays (CXR) are usually performed following a presentation with pneumonia to ensure radiological resolution. Persistent abnormalities should be investigated further to rule out underlying pathology. The aim of this study was to review local compliance and how this changed the management of these patients, particularly in the new diagnosis of respiratory conditions, including malignancy. Method: 489 episodes of community acquired pneumonia were identified retrospectively from September 2017 to July 2018. Admission and follow up CXRs, subsequent imaging, outpatient appointments and final diagnoses were reviewed. Results: 432 (88%) of pneumonia episodes resulted in follow-up CXRs. The median time to follow up was 6 weeks. 262 (61%) of CXRs showed complete resolution of changes, 86 (20%) showed partial resolution and 84 (19%) showed either persistence or progression of radiological abnormalities. 23 (27%) of the episodes with partial resolution had no further tests, 39 (45%) had a further CXR and 24 (28%) had a CT scan. 2 patients were ultimately diagnosed with lung malignancy and 5 with a non-malignant respiratory condition. Of those episodes with persistence or progression of changes, 17 (20%) had no further tests, 30 (36%) had a further CXR and 37 (44%) had a CT scan. 3 patients were found to have malignancy and 13 a non-malignant condition. In total, 5 patients (1%) were found to have a lung malignancy. Conclusion: Follow up CXRs can lead to new malignant and non-malignant diagnosis both when the radiological changes are persistent and when only partially resolved. Further work is required to risk stratify patients into higher and lower risk groups.