There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
The BTS/NICE COPD guideline recommends a chest X-ray at initial COPD evaluation; this
is a grade D recommendation based on expert opinion. We have investigated which pathologies
other than COPD are detected by chest X-ray and how they alter management. Dundee
smokers aged 40 or over and receiving bronchodilators are assessed for COPD by their
practice nurse and offered a chest X-ray if there is no record of a chest X-ray within
the previous three years. We retrospectively analysed the chest X-ray reports and
case records of these patients. The chest X-ray report was structured with 7 specific
questions, most importantly "Are there any features of other disease likely to be
causing dyspnoea?" and "Are there any features to suggest lung cancer?" Management
of patients with chest X-ray findings suggesting other disease causing dyspnoea or
lung cancer was assessed by questionnaire and case record study. Five hundred forty-six
consecutive chest X-ray reports were analysed. Fourteen percent of all chest X-rays
detected potentially treatable dyspnoea causing disease; where management following
receipt of X-ray reports was audited, 84% were thought to help. Eleven lung cancers
were detected, 3 had stage 1 disease. Considerable benign and malignant pathology
is detected by chest X-ray performed at initial COPD assessment. Clinical management
is changed in the majority with a potentially treatable abnormality. This evidence
suggests that the NICE guideline to perform chest X-ray at initial COPD evaluation
should be elevated from a grade D to grade C recommendation.