CT imaging in the severe COPD population; diagnostic usefulness and adherence to GOLD guidelines in the absence of a lung cancer screening programme

Chest CT is recommended in COPD patients with persistent exacerbations, symptoms out of proportion to airflow limitation, or FEV1 <45% with hyperinflation and gas trapping (Agusti et al, Eur Respir J 2023). While there is no lung cancer screening programme in Ireland, the European Commission has proposed screening those aged 50 to 75 years with a 30 pack year smoking history. The cases of 63 patients attending the severe COPD clinic over 12 months were reviewed. Nine were excluded as spirometry did not meet diagnostic criteria for COPD. Male:female distribution was 1:1 with an average age of 71 years and GOLD airflow stage 1/2/3/4 (n=10/16/23/5 respectively). 62% were in COPD Category E. 33 patients met lung cancer screening criteria and a further 12 met the GOLD criteria for chest CT. 13 had had a CT within the last 12 months, significant for emphysema (n=9), nodules (n=7), infection (n=6), bronchiectasis (n=2), mediastinal lymphadenopathy (n=2) and fibrosis (n=1). Significant co-morbidities detected included coronary artery disease (n=8) and thoracic wedge compression fractures (n=3). Sixteen patients had had a CT >12 months before review, with a mean time of 47 months (range 14-103 months). Chest CT in COPD is useful not just in the context of lung malignancy but also for confirming presence and severity of emphysema, suitability for surgical or endoscopic lung volume reduction procedures and assessing co-morbidities which impact on all-cause mortality in this group e.g. bronchiectasis, coronary artery disease, reduced bone mineral density and pulmonary hypertension.CT should be incorporated in the management strategy for this cohort.