The Use of Lung Cancer Screening to Increase Chronic Obstructive Pulmonary Disease Diagnosis in Veterans Affairs Primary Care.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is underdiagnosed and most diagnoses occur when the disease is advanced, which is associated with worse outcomes. Veterans have a higher prevalence of COPD compared to nonveterans, but some veterans are unlikely to report early symptoms of COPD and primary care practitioners (PCPs) do not routinely ask high-risk patients (aged 50-80 years with a smoking history ≥ 20 pack years) if they have symptoms. There is a pressing need for innovative methods to diagnose COPD earlier in its course.

Observations: Lung cancer screening (LCS) studies have found evidence of emphysema on computed tomography (CT) in patients without prior history of COPD. Detection of emphysema on CT allows PCPs to identify patients who may benefit from symptom screening, spirometry, and tobacco cessation efforts. In 2022, the Veterans Affairs Northeast Ohio Healthcare System internal medicine residents and faculty implemented a quality improvement project to increase early COPD diagnosis in primary care patients using CT for LCS.

Conclusions: We propose asking all patients who are eligible for LCS about their COPD symptoms and creating a clinical reminder for COPD screening in patients with tobacco use.