By integrating spirometry with low-dose CT scans, physicians at Philadelphia-based Temple University Health System are identifying serious lung conditions, such as chronic obstructive pulmonary disease, sooner.
Annual low-dose CT scans are recommended for patients with an increased risk of developing lung cancer, of which COPD is a common comorbidity, according to a Dec. 13 news release from Temple Health.
Pulmonologist Nathaniel Marchetti, DO, medical director of the respiratory intensive care unit at Temple University Hospital spoke to Becker’s about how the simultaneous screening can lead to earlier and more effective interventions.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What inspired Temple Health’s integration of spirometry and low-dose CT?
Dr. Nathaniel Marchetti: The group of patients undergoing lung cancer screening with low-dose CT have a very high risk for COPD because they’re sort of the heaviest of the smokers. There’s been data out of the U.K. over the last few years from what they call a “lung health check.” They would have a patient come in for low-dose CT imaging and combine it with spirometry. They found that up to 60% of patients with airflow obstruction didn’t even know that they had COPD.
We’ve known for a long time that COPD is way underdiagnosed because people don’t present. When people start to get short of breath, say in their 60s, they blame everything else in the world because they feel like they’re getting older. We end up missing the diagnosis that could have been made earlier.
Q: Can you share how the Temple Healthy Chest Initiative has operationalized this screening model?
NM: Four or five years ago, we set up a low-dose CT program at Temple and standardized how it would be ordered across the entire health system. We also found early in the days of lung cancer screening, it was really subspecialists that were ordering these things. We made it so that any primary care physician, nurse practitioner or physician assistant could order a low-dose CT scan if their patient met the criteria.
Since we know many patients should have had spirometry because of their symptoms, we made it an order set so when you order a low-dose CT scan an alert automatically pops up in Epic asking if you want to also order spirometry. It’s simply one extra click.
Q: For health system leaders looking to adopt a similar model, what are the key considerations that they should plan for?
NM: It adds complexity and some cost to it, but I would sort of argue that anytime you make something more complex, it is more expensive. But this is something that’s good for patients. It identifies a group that you’ve really got to pay close attention to. Money savings come because if you diagnose cancer or COPD earlier, it can hopefully lead to less hospitalizations and better outcomes for patients, which is going to be good for the bottom dollar of any healthcare institution.
Like most things that are new, lung cancer screening is still, we feel, underutilized. It takes a lot of work from the healthcare system to integrate this into everyday practice, and to make it easy for patients and physicians. That’s the only thing I would ask people to try to do — make screening easier for patients to access, easier for physicians to order and easier for radiologists to utilize interpretations.
Q: Do you think this type of “opportunistic screening” and others like it, will become standard practice in the future? Why?
NM: I do, actually, especially with CT scan imaging. When you do a CT scan of somebody’s chest, you catch the thyroid, the heart, the lungs, the chest wall, the spine, part of the liver, part of the stomach, the entire esophagus. To ignore those things makes zero sense. If you’re spending money for the CAT scan, you might as well utilize every bit of information you can from it to help improve patient care and help improve outcomes.
