A retrospective audit of patients with a radiological finding of moderate or severe emphysema. Should we perform spirometry as part of the targeted lung health check?

Abstract

Low dose computed tomography (LDCT), screening for lung cancer is being implemented in some European countries. The targeted lung health checks (TLHC) programme is a new and ground-breaking flagship programme of work in England which will contribute to the ambition of the NHS Long Term Plan to improve early diagnosis and survival for those diagnosed with cancer (NHSE, 2022). The Mansfield and Ashfield TLHC commenced in March 2021 and was part of phase one of the NHSE (National Health Service England) pilot programme. Participants invited for the TLHC are those who are, at the date of the first low dose CT scan, aged between 55 and 74 years, 364 days of age, are registered with a GP practice and have ever smoked. Those who are eligible will be assessed to calculate their individual risk of developing lung cancer within the next 5 years using a pre-defined algorithm that automatically calculates both Prostate, Lung, Colorectal and Ovarian (PLCO) (Hocking et al, 2010) risk prediction model and the Liverpool Lung project (LLP) (Cassidy et al, 2008). All identified high risk patients i.e., a risk threshold of ≥1.51% threshold for PLCO and/or ≥2.5 for LLPv2 algorithms, then go on to a face-to-face appointment with trained TLHC nurses to confirm their risk assessment and where it is proven high risk, a low dose computer tomography (LDCT). Incidental findings are detected frequently following a LDCT and have the potential to benefit or harm the participant, and their management adds costs (Morgan et al, 2017). Localised audit of the patients has found the largest cohort of patients with incidental findings within our programme was those with radiological findings of Emphysema. The question is should we routinely be offering spirometry to this patient group either as part of the TLHC programme or making recommendations to primary care to perform one and are there any benefits to the patient?