Background: Chronic obstructive pulmonary disease (COPD) and lung cancer are the leading causes of death globally, that share common risk factors such as age and smoking exposure.

Aim: To determine the prevalence of emphysema in high-risk population that underwent LDCT screening for lung cancer.

Methods: A secondary analysis of Lung Cancer Screening Database of Secretariat for Health Care of Autonomous Province of Vojvodina, Serbia between 20th September 2020 -30th May 2022. Persons aged 50-74 years, with a smoking history of ?30 pack-years/or ?20 pack-years with additional risks (COPD, prior pneumonia, other malignancy, family history of lung cancer and exposure to environmental carcinogens) were offered LDCT.

Results: Of total 1288 participants, mean age 62.1±6.7 years, 535 male (41.5%), 386 (30.0%) had emphysema. Majority of patients with emphysema (301/386, 78.0%) had no prior history of chronic lung diseases. Compared to patients without emphysema, patients with emphysema reported more dyspnea (140/386, 36.3% vs. 276/902, 30.6%, p=0.046), chronic cough (117/386, 30.3% vs.209/902, 23.17% p=0.007), purulent sputum expectoration (70/386, 18.1% vs. 95/902, 10.53%, p<0.001) and weight loss (45/386, 11.7% vs. 63/902, 7.0%, p=0.005).  Patients with emphysema had longer exposure to smoking (pack/years, 43.8±18.8 vs. 39.3±18.1, p<0.001) and higher prevalence of solid or semisolid lung nodules (141/386, 36.5% vs. 278/902 30.8%, p=0.04).

Conclusions: Almost one third of the patients who underwent LDCT screening had emphysema that was commonly undiagnosed despite being associated with significant symptom burden. Spirometry screening should be considered in high-risk population.