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CHRONIC OBSTRUCTIVE PULMONARY DISEASE
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Detection while asymptomatic doesn’t alter disease course or improve outcomes.
Several symptom-based questionnaires have high sensitivity for COPD.
In symptomatic patients (ie, dyspnea, chronic cough, or sputum production with a history of exposure to cigarette smoke or other toxic fumes), diagnostic spirometry to measure FEV1/FVC ratio is indicated.
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USPSTF 2013 , ASCO 2013, ACCP 2018
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–Screen for lung cancer annually with low-dose chest CT in adults ages 55–80 y who have at least a 30 pack-year smoking history.
USPSTF: age 55–80 y
ASCO: age 55–74 y
ACCP: age 55–77 y
–Stop screening if a person has not smoked for 15 y, or if they develop a significant medical problem that would limit ability to receive treatment for an early stage lung cancer.
–Do not screen routinely with chest x-ray and/or sputum cytology.
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American Cancer Society, NCCN 2018
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–Screen with low-dose chest CT if
age 55–74 y, a 30 pack-year smoking history, and cessation <15 y ago, or
age 50+, a 20 pack-year smoking history, and additional risk factors that raise the risk of cancer by 1.3% per the Tammegami lung cancer risk calculator (PLOS Med 2014;11;1-13).
–Screen for at least 3 consecutive years.
–Only screen if a highly skilled support team is available to evaluate CT scans, schedule appropriate follow-up, and perform lung biopsies safely when indicated.
–Employ shared decision-making.
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Less than 1 in 1000 patients with a false-positive result experience a major complication resulting from diagnostic workup.
Clinical insight:
Counsel all patients against tobacco use, even when age >50 y. Smokers who quit gain ~10 y of increased life expectancy and have maximum reduction in risk of lung cancer after 15 y of no tobacco use. (Br Med J. 2004:328)
Spiral CT screening can detect greater number of lung cancers in smokers with a >10-pack-year exposure. (N Engl J Med. 2006;355: 1763-1771)
The NCI has reported data from the National Lung Screening Trial (NLST), a randomized controlled trial comparing LDCT and CXR yearly × 3 with 8-y follow-up. A total of 53,500 men and women age 50–74 y, 30 pack-year smokers were randomized. A 20.3% reduction ...