Lung Health  

In Hong Kong, Lung Cancer was the most common cancer in men and the third commonest cancer in women. Lung cancer was also the leading cause of death from cancer in men and women. In the early stages, lung cancer usually has no noticeable symptoms. Hence, most patients are diagnosed at an advanced, and thus non-curable disease stage. Survival time of lung cancer patient decreases significantly with progression of disease. It is therefore crucial to detect lung cancer early, before symptoms occur and while curable therapy is still achievable.

Tobacco smoking, including second-hand smoke, is the most important risk factor for lung cancer. Screening is often considered for individuals with a significant history of heavy smoking. However, screening with chest X-ray or sputum cytology did not reduce lung cancer mortality. An important American landmark study* showed that screening with Low Dose CT Thorax (LDCT) in specified high risk population could reduce mortality 20% when compared using Chest X ray as screening tool.

 
 
 
Lung Function Test
 
The Procedure
The Test measures the amount and speed of air that could be inhaled into and exhaled from the Respiratory system (nose, larynx, trachea, bronchus and lung alveoli) pressure changes, volume of air inspired, expired or remained in the lungs during breathing, and alveoli gas exchange function. The test will not cause any pain but may cause some feeling dizzy or mild shortness of breath.
 
Clinical Applications
The Test could detect airway obstruction, lung restriction or gas diffusion defects. It may diagnose abnormalities in patient’s lung function, natures of abnormalities/defect, causes of shortness of breath, site of pathology, severity of illness. It could monitor the clinical course and predict the prognosis, assess the treatment response and help with pre-operative assessment.  
   
1. Spirometry  

Spirometry is the most commonly ordered lung function test. It could be used to differentiate “Obstructive” and “Restrictive” lung defect. It is useful to assess the severity of airway diseases, treatment response, lung function impairment, cause of shortness of breath, occupation related lung problems and surgical risk.

 
   
2. Bronchodilator/Reversibility Test  

Bronchodilator/Reversibility Test is performed when obstructive defect is found in the baseline spirometry. Bronchodilator will be given to the patient and spirometry will be repeated. This test is useful to demonstrate the reversibility of airway obstruction.

 
   
3. Lung Volume Examination  

Lung Volume Examination is useful to differentiate Restrictive lung defect from Obstructive lung defect. Total Lung Volume and Residual Lung Volume are two important components of this test. Lung volume is typically raised in patients with emphysema.。

 
   
4. Diffusing Capacity/DLCO  

Diffusing Capacity/DLCO uses Carbon Monoxide to measure the efficiency of gases exchange between lung alveoli and blood capillaries. It is a useful diagnostic test in Interstitial lung diseases and lung manifestation of systemic diseases.

 
   
5. Physiologic Evaluation Prior to Lung Resection-Lung Function Test  

Surgical resection for lung cancer will reduce the pulmonary and vascular reserve capacity. This functional loss needs to be estimated pre-therapy to determine whether an individual patient is able to cope with it and to maintain an acceptable quality of life.

The relative risk of postoperative morbidity and mortality can be predicted from preoperative forced expiratory volume in the first second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO). Surgical resection is usually acceptable if the predicted postoperative FEV1 and DLCO values are >40%.This can be estimated from the number of bronchopulmonary segments to be resected taking into account the regional distribution of ventilation and perfusion. Patients with lower values might benefit from a more extensive assessment through pulmonary exercise testing.

 
   

Reference : Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 28 (Supplement 4): iv1–iv21, 2017 doi:10.1093/annonc/mdx222

 
 
 
Conclusion
If one has airway diseases (Asthma or COPD), unexplained chronic cough, chest tightness or wheezing, then one should consider lung function test. Comprehensive Lung function test is also an essential risk assessment modality prior to lung resection.
 
Remarks:
This is general information only and the list of complications is not exhaustive. Other unforeseen complications may occasionally occur. In special patient groups, the actual risk may be different. For further information please contact your doctor. Evangel Hospital reserves the right to amend this leaflet without prior notice. We welcome suggestions or enquiries on the information provided in this leaflet. Please contact our ward nurses so that we could follow up and make improvement.
 
 
 
 
 
 
Lung Health Awareness Program & Lung Cancer Screening

Both lung cancer and chronic obstructive pulmonary disease (COPD) share similar risk factors (tobacco use and secondhand smoke in common). In addition, COPD is associated with an increased risk of lung cancer. LDCT for lung cancer screening may also identify previously undiagnosed COPD. Thus, both Lung cancer and COPD are common and potential lethal smoking related health hazards in Hong Kong.

Screening means testing for a disease when there are no symptoms of that disease. Doctor recommend a screening test to find a disease early, when treatment may work better in that person. Hence not everyone will get benefit from screening program. Our Lung Health Awareness Program targets at Lung Cancer and COPD screening in smoking population.

Target
● 55 to 80 years old
● Current smokers or people who have ever smoked

 
 
 
Lung Health Awareness Program

● Respiratory physician assessment
● Low dose CT thorax exam
     - effective in detecting lung cancer
● Lung function test
     - diagnosing & assessing the severity of COPD
● Chest X-ray
● Pulse Oximetry
● Investigation Report

 
 
 
Lung Cancer Screening

● Respiratory physician assessment
● Low dose CT thorax exam
     - effective in detecting lung cancer
● Chest X-ray
● Pulse Oximetry

 
 
 
 
 
 
 
Healthy Tips
 
 
 
 
 
 
 
If you have any one of following symptoms suspicious of lung cancer, please consult your doctor promptly for further investigation and management.

● Persistent or worsening cough
● Blood stained sputum
● Unexplained chest or shoulder pain
● Unexplained shortness of breath
● Unexplained loss of appetite & weight
● Recurrent chest infection

 
 
 
 
[*Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med 2011;365:395-409.]
 
 
 
Enquiry / Appointment
Tel : 2711 5222
 
 
 
 

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