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Chronic Obstr Pulm Dis. 2019 Jul 24;6(3):233-245. doi: 10.15326/jcopdf.6.3.2018.0142.

Identifying Smoking-Related Disease on Lung Cancer Screening CT Scans: Increasing the Value.

Author information

Division of Pulmonary Medicine National Jewish Health, Denver, Colorado.
School of Public Health, University of Colorado, Denver.
Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles.
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.
Pulmonary and Critical Care Medicine, Ann Arbor Healthcare System, Ann Arbor, Michigan.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scottland.
Channing Division of Network Medicine, Brigham Women's Hospital, Boston, Massachusetts.



Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most smokers die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of 3 comorbid diseases from LCS eligible scans and quantified related adverse outcomes.


We studied COPD Genetic Epidemiology study (COPDGene®) participants (n=4078) who met criteria for LCS screening at enrollment (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). CT scans were assessed for coronary artery calcification (CAC), emphysema, and vertebral bone density. We tracked the following clinically significant events: myocardial infarctions (MIs), strokes, pneumonia, respiratory exacerbations, and hip and vertebral fractures.


Overall, 77% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 51% of scans, emphysema in 44%, and osteoporosis in 54%. Adverse events related to the underlying smoking-related diseases were common, with 50% of participants reporting at least one. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. New diagnosis of disease was associated with significantly more adverse events than in participants who did not have CT diagnoses for both osteoporosis and cardiovascular risk.


Expanded analysis of LCS CT scans identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis that corresponded with adverse events. LCS CT scans can potentially facilitate diagnoses of these smoking-related diseases and provide an opportunity for treatment or prevention.


chronic obstructive pulmonary disease; comorbidities; copd; lung cancer screenings; smoking-related disease

Conflict of interest statement

Jeffrey L. Curtis reports grants from the National Heart Lung and Blood Institute, the National Institute of Allergy and Infectious Diseases and the Departments of Defense and Veterans Affairs, outside the scope of this project. Russell P. Bowler reports serving on advisory boards for GlaxoSmithKline, Boehringer Ingelheim and Mylan Pharmaceuticals and has received research grants from GlaxoSmithKline and Boehringer Ingelheim. Meilan K. Han reports consulting work for GlaxoSmithKline, Boehringer Ingelheim, Astra Zeneca and Mylan Pharmaceuticals and research support from Novartis and Sunovion. Edwin K. Silverman reports grant and travel support from GlaxoSmithKline in the past 3 years. Ms. Lowe and Drs. Regan, Make, Lynch, Kinny, Budoff, Mao, Dyer, Beaty, Hokanson, Kern, Humphries, Curran-Everett, van Beek, Crapo and Finigan have nothing to declare.

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