by Michael Woodhead

The value of a chest X-ray in the initial evaluation of patients with COPD has been confirmed in a new UK study showing that it identifies pathology in a significant number of patients.

Current guidelines that recommend an X-ray are based only on expert opinion, but the level of evidence is now higher, say UK researchers in the journal Respiratory Medicine (103: 1862) this week.

In a retrospective study of 546 chest X-rays from a cohort of smokers over 40 years old referred from primary care, the researchers found that14% detected potentially treatable dyspnoea-causing non-malignant disease such as lower respiratory tract infections, bronchiectasis and left ventricular failure. IN addition, lung cancer was found in 11 patients.

In almost all the patients the abnormality causing dyspnoea was unknown before prior to the X-ray screening and management was changed in about one in ten patients as a result of the X-ray, the researchers say.

The patients had been selected by practice nurses if they had dyspnoea and no record of a chest X-ray in the previous three years. When the patients were referred for X-ray, radiologists were asked to report in a structured fashion questions such as whether the lungs and heart were normal size, whether there was any significant emphysema, whether there were any features to suggest lung cancer, and any features of other disease likely to be causing dyspnoea.

The study authors say their findings show that all patients should have a chest X-ray to exclude pathologies other than COPD.

“Considerable pathology is detected by chest X-ray at initial evaluation,” they note,  which in many cases resulted in a change in management.