COPD Surfaces During Lung Cancer Screening

Approximately 20% of adults screened for early lung cancer met criteria undiagnosed chronic obstructive pulmonary disease (COPD), based on new data from approximately 300 individuals presented at the American Thoracic Society (ATS) 2026 International Conference.

“Patients undergoing lung cancer screening with low-dose CT scans represent a high-risk population for smoking-related lung disease, including COPD,” said lead author Stephen Dachert, MD, assistant professor of clinical thoracic medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia.

“While lung cancer screening programs are well established, COPD remains frequently underrecognized despite many patients having respiratory symptoms, airflow obstruction, and structural lung abnormalities detectable during screening,” Dachert told Medscape Medical News. Currently, the US Preventive Services Task Force does not recommend routine COPD screening, he noted.

To evaluate how often COPD was being missed and whether patients were receiving appropriate therapy, a particular concern in underserved populations, Dachert and colleagues reviewed data from electronic medical record, and pre-bronchodilator spirometry data were collected for 305 adults enrolled in the Temple Healthy Chest Initiative. Symptom burden was assessed using questionnaires about prior inhaler use and the COPD Airway Assessment Test (CAAT). The median age of the participants was 63 years; 182 were women, and 187 were active smokers. Most of the participants (228) self-identified as Black/African American, 42 as non-Caucasian Hispanic, and 31 as White/Caucasian.

About half of the participants (52%) had no previous COPD diagnosis. Of these, 49 (31.2%) had evidence of airflow obstruction, and almost all (97%) had symptoms defined as CAAT scores of > 1 for mucus, cough, or breathlessness.

Overall, “Twenty-one percent met criteria for undiagnosed COPD based on airflow obstruction and positive CAAT symptoms, and many had moderate disease severity by GOLD COPD classification,” Dachert said.

The high prevalence of previously undiagnosed COPD, despite a substantial symptom burden, was a striking finding, Dachert told Medscape Medical News. “We were also struck by the degree of undertreatment, with more than 60% of these patients not receiving any inhaler therapy,” he added. Among the 48 undiagnosed COPD patients in the total cohort, approximately 10% had received short-acting beta 2-agonist-only therapy.

“While prior studies have suggested underdiagnosis in lung cancer screening populations, the magnitude seen in this predominantly minority cohort reinforces how common missed opportunities for diagnosis remain in clinical practice,” Dachert said.

The findings were limited by the use of data from a single region and may not be generalized to other areas. However, the results suggest that lung cancer screening (LCS) programs are an opportunity to identify and treat chronic smoking-related lung disease, Dachert said. “Incorporating spirometry, symptom assessment, and review of respiratory therapies into LCS programs may help identify patients with clinically significant but previously unrecognized COPD, and earlier diagnosis could allow for smoking cessation reinforcement, initiation of evidence-based inhaler therapy, symptom improvement, and potentially reduction in exacerbations and health care utilization,” he said.

“Future studies should evaluate whether systematic COPD screening embedded within lung cancer screening programs improves clinical outcomes such as quality of life, exacerbations, hospitalizations, and healthcare utilization,” Dachert said. Additional work is needed to determine the best combination of screening tools to efficiently identify high-risk patients, which may include spirometry, quantitative CT imaging, symptom questionnaires, and biomarkers, he noted. “Longitudinal studies may help clarify whether earlier identification during lung cancer screening changes disease trajectory over time,” Dachert added.

Value Added for Underserved Populations

The new study’s results suggest that incorporating routine symptom assessment and spirometry into LCS pathways may improve earlier diagnosis and optimization of COPD management, said Jesse R. Sherratt, DO, a pulmonologist and critical care specialist at the University of Texas Health Science Center at San Antonio.

“Individuals undergoing lung cancer screening are at particularly high risk for smoking-related lung disease, yet COPD frequently remains unrecognized and untreated in this population,” said Sherratt, who was not involved in the study. The current study highlights the potential value, particularly among underserved populations, of incorporating spirometry and symptom assessment into LCS programs for earlier identification of patients with clinically significant COPD, he said.

The high rates of undiagnosed COPD and undertreatment were not unexpected, given the substantial smoking exposure and high-risk characteristics of patients undergoing LCS, said Sherratt. “However, the degree of symptom burden and the disproportionate impact on minority populations were especially notable and emphasize ongoing disparities in respiratory healthcare access and diagnosis,” he said.

“Additional studies are needed to determine whether integrating spirometry and structured COPD screening into lung cancer screening programs improves long-term clinical outcomes, healthcare utilization, and quality of life,” Sherratt noted. Further research also should evaluate strategies to reduce disparities in COPD diagnosis and treatment among minority populations, he said.

The study was supported by grants from AstraZeneca and the Temple Lung Center. AstraZeneca collaborators participated in the study as coauthors. Sherratt had no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.