Incidental findings on chest X-ray or CT scans of COPD or emphysema

Incidental findings on chest X-rays or CT scans

• primary care respiratory review and spirometry should be considered for people with emphysema or signs of chronic airways disease on a chest X-ray or CT scan
  
• if the person is a current smoker, their spirometry results are normal and they have no symptoms or signs of respiratory disease:
  • offer smoking cessation advice and treatment, and referral to specialist stop smoking services
  • warn them that they are at higher risk of lung disease
  • advise them to return if they develop respiratory symptoms
  • be aware that the presence of emphysema on a CT scan is an independent risk factor for lung cancer
    
    if the person is not a current smoker, their spirometry is normal and they have no symptoms or signs of respiratory disease:
  • ask them if they have a personal or family history of lung or liver disease and consider alternative diagnoses, such as alpha-1 antitrypsin deficiency
  • reassure them that their emphysema or chronic airways disease is unlikely to get worse
  • advise them to return if they develop respiratory symptoms
  • be aware that the presence of emphysema on a CT scan is an independent risk factor for lung cancer

Reference:

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.
2. NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE guideline NG115. Published December 2018, last updated July 2019