Targeted COPD testing proposed as part of NHS lung cancer checks

A total of £33m could be saved over the next decade through the introduction of targeted COPD case finding as part of NHS lung cancer checks, research has suggested.

The figures are based on a pilot project in Hull which found almost half of people at high risk identified through the NHS lung cancer screening programme were subsequently diagnosed with COPD.

A quarter of them had a chest infection in the year before being assessed at the COPD clinic, suggesting a missed opportunity to start treatment, figures presented at the European Respiratory Society Congress showed.

The mean COPD assessment test (CAT) score was 15.5, suggesting the condition was already having a substantial impact on people’s day to day lives.

So far more than 1.2 million lung checks have been done though the national programme which offers CT scans to those at high risk of lung cancer.

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But while incidental findings of emphysema are common, there are no consistent pathways for diagnosing patients with COPD after a screen.

To test whether this would be a good opportunity for picking up undiagnosed cases, the FRONTIER project at Hull University Teaching Hospitals NHS Trust set up a dedicated nurse-led one-stop clinic.

Patients who meet the criteria for possible COPD as identified at their cancer screening, are offered an appointment for symptom assessment and lung function testing.

Over a year period, 819 people were seen in the clinic – set up in partnership with inhaler manufacturer Chiesi – with 383 (46.8%) diagnosed with COPD.

Assuming each ICB invites 1,000 high risk patients for COPD evaluation in a year, the team estimated this could save £33 million over ten years in reduced emergency admissions.

An interim analysis of the project presented last year had shown that 70% of the first 200 patients were diagnosed with COPD.

The team said at the time they expected this figure to fall as those with the most severe emphysema had been invited first.

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Professor Michael Crooks, consultant in respiratory medicine at NHS Humber Health Partnership and professor of respiratory medicine at Hull York Medical School, University of Hull, said: ‘In those being diagnosed with COPD through the FRONTIER programme, one in four have been treated for chest infections during the year before, indicating exacerbations of their undiagnosed COPD.

‘This emphasises the value of making an early diagnosis, so that people living with undiagnosed COPD can access treatments to improve their symptoms and reduce their risk of exacerbations, which we know are serious events with long-term consequences.’

The proactive, targeted approach aligns with the NHS 10-Year Health Plan to prioritise prevention over treatment to improve long-term outcomes for patients, the team added.

An estimated 1.7 million people in the UK live with COPD with around 600,000 more undiagnosed.

The condition is the second most common cause for emergency admission to hospital.

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Figures from 2023 suggest it accounts for 1.4 million GP consultations a year.

Earlier this year Asthma+Lung UK found that more half of ICBs do not have enough spirometry testing capacity to meet demand.

A version of this article was first published by our sister title Pulse