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B44-01 Using Lung Cancer Screening to Reduce Underdiagnosis of Chronic Obstructive Pulmonary Disease
Abstract   Peer reviewed

B44-01 Using Lung Cancer Screening to Reduce Underdiagnosis of Chronic Obstructive Pulmonary Disease

S Fortis, S Wardyn and R Smyth
American journal of respiratory and critical care medicine, Vol.212(Supplement_1), aamag1621796
05/01/2026
DOI: 10.1093/ajrccm/aamag162.1796

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Abstract

Rationale The U.S. Preventive Services Task Force advises against routine spirometry screening in the general population due to insufficient evidence of benefit. However, targeted spirometry may support early detection and management of COPD in high-risk individuals, such as those undergoing lung cancer screening. In this single-center quality improvement initiative at the Iowa City Veteran Health Administration (VHA) medical center, we aimed to reduce underdiagnosis of COPD among lung cancer screening participants without a prior COPD diagnosis. We evaluated the characteristics of individuals with newly diagnosed COPD and assessed changes in medication use and dyspnea following a structured intervention. Methods We reviewed electronic medical records of individuals who received a lung cancer screening consultation at the Iowa City VHA between October 2024 and June 2025. Exclusion criteria included prior abnormal spirometry (pre- or post-bronchodilator FEV1, FVC, or FEV1/FVC Results Of 329 individuals screened for lung cancer, 166 met eligibility criteria, and 62 completed spirometry and pulmonary consultation. Participants were predominantly male, white, and rural. Sixteen individuals were newly diagnosed with COPD (defined as FEV1/FVC < LLN). Compared to those without COPD, individuals with COPD had significantly lower lung function and greater symptom burden. The FEV1%predicted was lower in the COPD group (Median 74.00 [IQR: 62.23–83.20]) compared to the non-COPD group (Median 98.35 [IQR: 88.85–111.90]; p < 0.001). The mMRC dyspnea score was higher among individuals with COPD (Median 2.00 [IQR: 1.00–3.00]) than those without COPD (Median 1.00 [IQR: 1.00–2.00]; p = 0.031). Among the 16 patients with COPD, 5 received both short-acting and long-acting bronchodilators, 9 received only long-acting agents, and 1 received only short-acting bronchodilators. Of the 40 participants who completed the follow-up survey, 37 reported high satisfaction with spirometry, and 36 appreciated the pulmonary consultation. Conclusion Spirometry combined with pulmonary consultation and inhaler prescription identifies COPD in a lung cancer screening population of predominantly rural Veterans, with a number needed to screen of 3.88. The intervention was well-received and may support earlier diagnosis and treatment in high-risk populations. This abstract is funded by: VHA Office Rural Health Award #PROJ-30862
 Lung Cancer Medical Screening Bronchodilators Chronic obstructive pulmonary disease Dyspnea Spirometry

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