For people with a history of smoking and evidence of emphysema on low-dose chest computed tomography (LDCT) screening, new research suggests a threefold higher risk of mortality due to chronic obstructive pulmonary disease (COPD) over the next 25 years.
For the prospective study, recently published in Radiology, researchers examined LDCT screening data for 9,047 individuals (median age of 65) who had a median of 43 pack-years of smoking. The study authors noted severe emphysema in 217 participants, moderate emphysema for 512 people and mild emphysema in 1,908 individuals.
The researchers found that emphysema detection on LDCT was associated with higher mortality risks over a subsequent 25-year period as follows:
• over a threefold higher risk of COPD-related death;
• a 29 percent higher risk of all-cause mortality; and
• a 14 percent higher risk of cardiovascular disease (CVD) mortality.
Here one can see axial low-dose CT scans showing mild emphysema in a 67-year-old male patient (A), moderate emphysema in a 69-year-old man (B) and severe emphysema in an 85-year-old woman. New research suggests that emphysema on low-dose chest CT is associated with over a threefold higher risk for chronic obstructive pulmonary disease (COPD) mortality within 25 years. (Images courtesy of Radiology.)
“Clinically, these findings suggest emphysema is not merely an incidental CT finding but a distinct disease entity associated with worse outcomes and increased mortality, not only from lung cancer but also from respiratory and CVD deaths. A comprehensive lung cancer screening program should also assess COPD and CVD risk to identify individuals who may benefit from targeted interventions and vigilant cardiovascular prevention to improve outcomes,” wrote study co-author Claudia I. Henschke, M.D., who is affiliated with the Department of Diagnostic, Molecular and Interventional Radiology at the Icahn School of Medicine at Mount Sinai in New York City, and colleagues.
While emphysema continued to be associated with a threefold higher risk for COPD mortality during the adjusted risk analysis, the study authors noted no association between emphysema and CVD mortality when considering confounding risk factors.
Three Key TakeawaysEmphysema on LDCT strongly predicts COPD mortality. Individuals with emphysema had over a threefold increased risk of COPD-related death over 25 years, highlighting emphysema as a key prognostic marker.Broader mortality impact. Emphysema was also associated with a 29 percent higher risk of all-cause mortality, underscoring its significance beyond lung cancer detection in screening populations.Lung screening should expand beyond cancer. Findings support incorporating COPD and cardiovascular risk assessment into lung cancer screening programs to guide targeted interventions and preventive care.
However, the researchers emphasized that CVD has been linked to emphysema in a variety of previous studies.
“Emphysema is linked to impaired left ventricular filling, reduced stroke volume, and lower cardiac output despite preserved ejection fraction. Hyperinflation worsens pulmonary vascular resistance, reduces venous return (cardiac preload), and decreases cardiac chamber size,” pointed out Henschke and colleagues.
(Editor’s note: For related content, see “Olympus Launches CT-Based AI Software for Emphysema Screening,” “Chest CT Study Shows Higher Emphysema Risk from Combination of Marijuana and Cigarette Smoking” and “Chest CT Research Reveals at Least One Lung Nodule in 42 Percent of Non-Smokers.”)
In regard to study limitations, the authors acknowledged variable CT scanning parameters during the study period, use of a scoring system for assessing emphysema that predates the Fleischner classification, and the lack of automated quantification for emphysema evaluations.