Comparing Advanced Technologies to Standard Testing for the Diagnosis of Airway Disease in Hospital and Community Settings

BREATHE: Benchmarking Respiratory Evaluation of Advanced Technologies for Healthcare Excellence

Airway disease, such as chronic obstructive pulmonary disease (COPD), is usually diagnosed through breathing tests like spirometry. However, it requires people to blow forcefully into a machine several times which can be uncomfortable and difficult for some patients.

This study is looking at whether newer technologies and other breathing tests can help diagnose COPD as accurately as standard testing. We will compare these tests in both hospital and community settings. We are interested in understanding how practical and cost-effective these tests are, including how easy they are to use and how comfortable they are for patients to perform.

Long-term lung conditions such as COPD affect around one in five people and are the third leading cause of death in England. These conditions are often not picked up until they have reached an advanced stage, and sometimes people are given an incorrect diagnosis. They cause breathing difficulties due to lung damage, which cannot be reversed in the case of COPD.

At present, lung conditions are usually diagnosed through breathing tests like spirometry. These tests require people to blow forcefully into a machine several times, which can be uncomfortable and difficult for some patients. They also rely on specialist equipment and must be carried out and interpreted by highly trained professionals. Because there aren't enough of these professionals, waiting lists can be long. Even when spirometry is possible, it does not always detect lung disease early.

Two national NHS programmes - the Community Diagnostic Centre (CDC) programme and the Lung Cancer Screening (LCS) programme - create opportunities to find lung disease earlier. However, the same challenges with spirometry remain.

Recently, new types of lung tests have been developed. These tests may be simpler, quicker, and cheaper to use, but they are not yet part of standard NHS care. We need to find out whether these new tests can identify lung disease as well as, or better than, spirometry, especially at earlier stages. If they can, they may help prevent further lung damage and improve health outcomes. It is also important to understand how practical and cost-effective these tests are, and whether they could be used widely in different healthcare settings.

To explore this, we will carry out the new tests alongside traditional lung function tests in both community and hospital settings. We will invite adults with possible COPD who:

• have been referred for spirometry at local CDCs,
• have been referred for lung function testing at secondary care hospitals,
• are attending for a lung scan as part of the LCS pathway, and
• are attending local community groups or events.

Participants may also be asked to complete short surveys or optional interviews to share their experiences. Healthcare professionals working in testing centres will be invited to do the same. We are especially keen to hear from people who live with lung conditions or who experience health inequalities, so that we can understand how easy the tests are to use, how comfortable they are, and whether they could work well across different healthcare settings.

Inclusion Criteria:

• ≥ 18 years of age
• New referral to community or secondary healthcare services
• Clinical suspicion of airway disease/COPD
• Able to provide fully informed written consent
• Able to fully understand and cooperate with the study protocol
• Clinically stable with no contraindications to lung function testing (outlined below)

Exclusion Criteria:

• Confirmed diagnosis of COPD
• Not willing and/or able to provide fully informed written consent to participate
• Has a relative contraindication to lung function testing [18]:
• Recent thoracic, abdominal or eye (e.g. cataract) surgery < 6 weeks
• Unstable cardiovascular status, including recent myocardial infarction or pulmonary embolus < 6 weeks
• Pneumothorax < 6 weeks
• Haemoptysis of unknown origin < 6 weeks
• Thoracic, abdominal or cerebral aneurysm
• Chest infection < 6 weeks
• An acute illness or symptom that might interfere with test performance (e.g. nausea, vomiting).
• The presence of any other clinical condition that would prevent the individual from safely performing lung function tests