Although elexacaftor/tezacaftor/ivacaftor (ETI) improves clinical outcomes in the population with cystic fibrosis (CF), little is known about factors influencing response at an individual level. To look at this, we investigated individual outcomes to ETI in our large adult CF clinic. We looked at lung function (ppFEV1), body mass index (BMI) and annualised IV antibiotic days in the 12 months before and after commencing ETI in 293 adult pwCF (mean age 33 years, 44% female). Mean medicines possession ratio was 85%. Using multiple linear regression modelling to explore which baseline clinical characteristics (sex, age, genotype, ppFEV1, BMI, IV days, CF-related diabetes, CF-related liver disease, ABPA, colonisation with Pseudomonas aeruginosa or Staphylococcus aureus) might predict ETI response. Lowest quartile subset for each outcome were classed as "poor responders." Although relative improvement in ppFEV1 was +13.5% (71.1% [22.6] to 79.3% [23.2]), greatest improvement was independently predicted by lower baseline ppFEV1 y (β = –0.002, p < 0.001), DF508 homozygosity (β = 0.18, p < 0.001) and lower age at initiation (β = –0.002, p = 0.02). Mean [SD] baseline BMI was 24.3 [4.6] kg/m2 and mean [SD] relative increase in BMI was +3.9% [7.4]. Only poorer baseline values predicted greater improvement in BMI and higher annualised IV days (β = –0.004, p = 0.0003 and β = –0.84, p < 0.001 respectively). 'Poor responders' in one outcome were not at greater risk of being poor responders in other outcomes (relative risk [95%CI] 0.73 [0.5 to 1.1], p = 0.18). ETI responses are heterogenous but those with more severe baseline impairment in FEV1, BMI and those with greater IV days had the greatest respective outcome response. Homozygosity for DF508 predicts improvement in ppFEV1 but not BMI or IV days. Importantly, poor response in one domain does not predict poor response overall. More work is needed to characterise long-term response trajectories to ETI.

Background: As people with cystic fibrosis (pwCF) grow older there is increasing concern regarding long-term cardiovascular risk. However, relatively little is known about the risk of cardiovascular disease in people receiving CFTR modulator therapy, i.e. elexacaftor/tezacaftor/ivacaftor (ETI). To investigate this, we investigated the effect of ETI on parameters relevant to cardiovascular disease in those with cystic fibrosis related diabetes (CFRD). Methods: We performed a retrospective analysis of all adults with CFRD at our large adult CF centre for the time period 2018–2022. Clinical characteristics and constituent variables of the QRISK3 score were recorded, and QRISK3 scores were calculated to estimate the 10-year risk of cardiovascular events (QRISK3 package, RStudio). Paired t-tests were used to compare the difference between QRISK scores of baselines and one-year post-ETI. Results: Complete data were available for 48 adults with CFRD. At baseline, the mean [SD] age was 39.9 [10.5] years, 29/48 (60.4%) were male and the mean BMI was 23.7 [4.9]. The QRISK3 10-year risk of heart attack or stroke was significantly higher in the year after ETI (5.9%) compared to preinitiation of ETI (4.6%, mean difference +1.3%, P = 0.03). This result appeared to be largely driven by increases in weight with a mean +4.2 kg resulting in increasing body mass index (23.7 [4.9] to 25.3 [4.7] kg/m2, p < 0.001), with contributory small increases also observed for systolic BP (mean [SD] 123 [14.8] to 129 [15.5] mmHg), and total cholesterol (mean [SD] 3.5 [1.0] to 3.8 [1.1]). Conclusions: ETI use is associated with significant improvements in weight and BMI, key prognostic outcomes for people living with CF. Our study suggests that one of the unexpected consequences of ETI therapy may be an increased cardiovascular risk. Further work is needed to determine and predict long-term cardiovascular risks in people with cystic fibrosis. Tabled 1YearChronic PAiAB for chronic PAIntermittent PAiAB for inter-mittent PAPA NegativeiAB for PA negative201224.1%72.5%33.8%51.7%27.8%17.4%201623.0%80.0%31.6%56.0%31.3%16.7%201922.4%79.2%28.6%55.8%35.0%13.6%Note: Each year ~14% had insufficient cx's to define their PA status. Open table in a new tab Note: Each year ~14% had insufficient cx's to define their PA status.

Introduction: Although people living with cystic fibrosis (pwCF) have high rates of key risk factors for cardiovascular disease, e.g. diabetes and chronic inflammation, little is known about the long-term cardiovascular risk in this condition. We aimed to determine the characteristics, rates, and riskfactors for cardiovascular disease in cystic fibrosis. Methods: We looked at prevalence, incidence and risk factors for cardiovascular disease in 5649 adult pwCF in the UK CF Registry and 6025 in the TriNetX Registry. We used propensity-matched analyses to compare the risk of major adverse cardiac events (myocardial infarction, left-sided heart failure, atrial fibrillation; MACE-AF) in pwCF with general population as well as to other inflammatory diseases. Results: pwCF had high prevalence of diabetes mellitus (35% in the UK CF Registry, 20% in TriNetX), but low rates of hypertension (2.2% and 7% for UK CF Registry and TriNetX respectively) and obesity (5.5% and 6% respectively). Classic cardiac risk factors (age, diabetes, hypertension) were associated with MACE-AF, but relationships between CF-specific risk factors (lung function and intravenous antibiotic usage) were also observed. In propensity-matched analyses, pwCF had a higher relative risk of MACE-AF compared to age/sex matched general population (Relative Risk [95% CI] 3.52 [2.9 to 4.3], p <0.001), and when adjusted for cardiac risk factors, equivalent or higher relative risk than other inflammation conditions considered "high-risk" for cardiovascular disease including rheumatoid arthritis (RR 1.28 [1.1 to 1.5], p < 0.001), systemic lupus erythematosus (RR 0.93 [0.8 to 1.1], p = 0.30) and human immunodeficiency virus (RR 1.09 [0.9 to 1.3], p = 0.24). Conclusion: As people with cystic fibrosis grow older they may be at increased risk of adverse cardiovascular disease events. Future work should focus on defining determinants of cardiovascular risk such that appropriate risk stratification can be employed.

result in inaccurate measurement of FEV 1 and FVC.Manchester Adult CF Centre has transformed from hospital to home-based spirometry testing during COVID-19.Unlike hospital-based spirometry, home-based spirometry relies entirely on the subject to obtain good quality spirometry.Therefore, we sought to ascertain the quality of home-based spirometry and the test errors in our patients.Methods: A convenience sample of adults with CF attending Manchester Adult CF Centre were provided with a NuvoAir home-based spirometer to perform routine lung function between March-October 2020.NuvoAir respiratory platform consists of a mobile phone application, Bluetooth spirometer and an online results portal.The spirometer also provides feedback to patients' spirometry quality.Initial patient set-up was performed in-hospital or virtually with a member of the CF clinical team.All patient sessions were included irrespective of quality of spirometry test session.Acceptability and repeatability criteria were applied as per NuvoAir software in line with ATS/ERS guidelines, along with assigning a quality grading A-F according to ATS/ERS standardised pulmonary function report criteria at time of testing.Results: 66 CF patients (32 female) mean age 31.3 (18-55) performed 343 spirometry sessions totaling 1,041 individual spirometry tests with a NuvoAir device were graded as follows: Grade A = 30.3%,Grade B = 36.2%,Grade C = 3.5%, Grade D = 2.6%, Grade E = 16.6%,Grade F = 10.8%.Further analysis of all 1,041 tests for common errors indicated BX -Back extrapolation 2%, TP-Time to Peak (slow start) 14.6%, CO -Cough 1.4%, ET -Early termination 0.5%, CE -Cessation or glottic closure 12.9%.Overall, general tests A-C considered usable was 70%. Conclusion:The results show good-quality standards can be achieved through home-based spirometry.

Liverpool has high levels of deprivation and one of the highest rates of respiratory morbidity in England with double the incidence of lung cancer, most prevalent in the lower socioeconomic groups. To tackle this health inequality, in February 2016 in partnership with Liverpool CCG, Liverpool University, and primary care, we embarked on the 4-year Liverpool Healthy Lung Project. Based on primary care records, individuals aged 58-75 with COPD, a history of smoking or asbestos exposure were invited to a face-to-face lung health check conducted by an experienced respiratory nurse. At this interview positive lifestyle messages were promoted and their 5-year personal lung cancer risk calculated (www.MyLungRisk.org) using the LLPv2 risk model. Those without a diagnosis of COPD underwent spirometry, and those who triggered the 5% threshold lung cancer risk threshold were offered a low dose thoracic CT scan. We now report our results to January 2019. 8350 of 21409 (40%) patients invited to the lung health check had attended. Of these, 5501 (59%) underwent spirometry and 10% were diagnosed with COPD. A further 2947 (35%) underwent the CT scan and of these 98 (3.3%) were suspicious of malignancy. Lung cancer was ultimately diagnosed in 55 (1.9%) and 45 of these (81%) were offered radical treatment. Of the remaining 43 patients, 10 underwent an invasive test and there was 1 benign resection. 265 patients (9%) needed repeat scans for lung nodules. These early results show that this innovative project is already improving access to respiratory healthcare in a deprived area of Liverpool, has identified new COPD patients, and over time should improve outcomes for lung cancer in this disadvantaged population.

To improve the patient experience in lung cancer, in 2014 we introduced to the UK the concept of "virtual" clinic working, where following secondary care review of suspicious CT scans taken in the community a lung cancer nurse specialist (LCNS) conducts a clerking/holistic assessment via telephone and offers an investigation plan where appropriate. In 2017, this model of care was adopted into UK National Lung Cancer Optimal Pathway guidance. We were interested to review the effect of our innovative service on patient experience. We looked at patient feedback, staff perceptions and impact on the lung cancer pathway of our virtual clinic 2016-18. Of the 1498 patients with a suspicious CT scan, over 75% were diagnosed with cancer. Overall 802 (70%) were diagnosed via the outpatient service and 705 (88%) chose virtual clinic assessment and diagnostic test facilitation. Qualitative audit has shown an overwhelmingly positive feedback, where 98% of users felt that the virtual clinic was a better option, and patients felt well informed and supported. In addition, the LCNSs feel they are utilising their knowledge and skills in a more timely fashion with an appropriate population. The early assessment facilitates the start of that therapeutic relationship that leads to patient needs being addressed, symptom management advice, reducing distress and optimising patient performance status and quality of life. Furthermore 'virtual' working has seen a dramatic reduction in medical outpatient activity, allowing that resource to be used more efficiently for the benefit of cancer patients. This service review has shown that the data and patient and staff experience all support this new model of care delivery. The benefits are multifocal: care is patient-centred, appropriate skill-set use improves staff morale, and the freeing up of infrastructure allows organisational resource reallocation and cost saving. We have advocated the role of the LCNS to take the lead in this model of working across the UK, as we feel the LCNS are best placed to do these sensitive and complex assessments. We welcome the opportunity to share our experience worldwide.

Results: 40 potential drug allergies were identified in 26 patients.9 were a recorded reaction to ceftazidime.Reactions were also common to tazocin (3), co-amoxiclav (3) and meropenem (3), with some patients having more than one recorded allergy.Of the suspected drug reactions 26 had an EDMS alert present and 3 had been referred for formal allergy testing.42 potential drug intolerances were also recorded, of which 14 had an EDMS allergy alert present.Conclusion: There are a large number of potential drug allergies in our CF population; however they are not consistently recorded.The majority of reactions are to antibiotics, which is unsurprising due to the high lifetime exposure to these agents.The low referral rate of suspected allergies for formal allergy testing is of significance as it impacts on the utilisation of these antimicrobials for future management.A more robust system has been implemented to ensure allergies are documented consistently.CF patients with a reaction to β lactams meet the UK National Institute for Clinical Excellence criteria for a referral to a specialist drug allergy service, and we would recommend that CF services implement this advice.

IntroductionThe Liverpool Healthy Lung Programme (LHLP) was designed to improve respiratory health and diagnose disease at an early stage. However, such programmes often produce unexpected findings, including nodules that require follow-up. We wished to look at the outcome for this subset of patients.MethodsWe identified all patients attending the LHLP who were subsequently referred to our centre for nodule surveillance, and recorded the outcome in terms of imaging and ultimate diagnosis for those who have undergone repeat scans.Results191 patients were referred for nodule surveillance over a two year period (81, 3-month and 110, 12-month scans) : 42 still await an initial 12-month scan. Of those undergoing a 3-month scan, 16 required further scans (range 2–5), 1 had malignancy, and 7 have ongoing surveillance. Of those undergoing an initial 12-month scan, malignancy was excluded in 62 (3 required further scans), it was diagnosed in 2, and the remainder continue surveillance. Overall, 135/149 patients have completed nodule surveillance with no increase in size and require no further follow up. Of these, malignancy was ruled out in 124 (91.8%) after only a single further scan. 3 cancers (1,Stage III squamous cell carcinoma treated with radiotherapy, 1, Stage IV small cell lung carcinoma managed palliatively, and 1 Stage I large cell neuroendocrine cancer resected) were diagnosed.DiscussionNodules detected during screening represent a challenge for screening programmes given that many are benign and patients may be exposed to unnecessary investigation and anxiety. Good nodule guidance has reduced the percentage of scans which enter surveillance. Our data confirms a low cancer detection rate (2.5%) in nodules referred from the LHLP setting. Reassuringly cancer could be excluded in 92% of patients after only one further scan, suggesting the harms from this approach are minimal for the vast majority of patients.

The Liverpool Lung Cancer Unit is a unique diagnostic service diagnosing approximately 430 patients per year. Although the majority of cases of suspected lung cancer can be managed as outpatients where the diagnostic pathway is well developed, a proportion still present unwell via the emergency department where their subsequent journey is less certain. Along with same-day reporting for emergency scans, we have developed a rapid review service for such individuals and were interested in assessing its performance. We looked at all patients with suspected lung cancer who presented through our emergency department at The Royal Liverpool University Hospital in 2018, focussing on outcome, time to be seen following admission, and the histological diagnosis rate. Of the 561 referrals to our lung cancer unit, 196 (35%) presented through the emergency department: 73 (37%) were discharged to outpatient cancer investigation. The remaining 123 (63%) were admitted to 26 different locations (8 medical specialities, surgical, vascular and orthopaedic wards). Of these, 72% were seen by the lung CNS within one working day and appropriate management initiated. This was aided by our live CT scan database, where 69/79 (87%) were coded on the same day. Daily CNS checks of the database ensure early inpatient identification and review by the lung clinician and CNS, often before formal referral from the responsible clinical team is made. Overall 103 patients (84%) who presented as emergencies subsequently were diagnosed with a malignancy. 96 were diagnosed with a primary lung cancer of which 56 (58%) had histological confirmation. Our results show that, by coordinating care between the emergency and radiology departments and the lung cancer team, patients presenting unwell can be managed rapidly even if they remain in hospital. In addition, by actively seeking them out we can not only provide them with timely and appropriate investigations but also early CNS intervention, facilitating symptom management, the opportunity to maximise their performance status and offer psychological support to not only the patient but to their families as well. This approach also ensures that the managing medical teams are given the right information from a specialist team. The Lung Cancer Team resource is therefore focussed on looking after lung cancer patients and those patients that do not have cancer but are referred to the team are informed at the earliest opportunity and treatment decisions made accordingly by the team responsible for their care.

the outcomes of rheumatology review of patients presenting to their CF teams with MSK symptoms.Methods: Patients with active MSK symptoms were identified during clinical review by CF clinicians and physiotherapists, and by screening questionnaire.Subjects were reviewed by a rheumatologist with a special interest in CF joint disease; diagnostic outcomes and management recorded.Results: 70 patients, 15% out of a total clinic of 450, were referred.19 had an inflammatory arthritis (27%), and a further 18 (26%) possible inflammatory arthritis.Other diagnoses included gout, vasculitis, adhesive capsulitis, fibromyalgia, and trochanteric bursitis.30 (43%) had non-inflammatory MSK pain, the commonest cause of this was muscle deconditioning.Following review, 34 (49%) had medication changes, including alterations to disease modifying anti-rheumatic drug prescriptions in 13, analgesia in 16, and corticosteroids in 7. 51% required Rheumatology follow-up.43% were referred on for MSK physiotherapy, in addition to those already receiving this.Conclusion: MSK symptoms requiring specialist review are common in adults with CF.Many patients were found to have a possible or probable inflammatory arthritis.The majority of reviews resulted in a change to long term therapy.Musculoskeletal issues need to be asked about, assessed and addressed by the CF team.This must include referral for specialist Rheumatology input in cases where the underlying cause is felt to be possibly inflammatory or unclear.Access to both MSK physiotherapy and Rheumatology services from CF centres is important to provide these patients with appropriate care.It is vital that a broad differential is considered with people with CF presenting with MSK pain to enable appropriate treatment.

bacterial population sequencing) and phenotypic assessment of the populations.Results: A higher proportion of CIP resistance in the Δ katA CIP-evolved biofilm populations was detected compared to Δ katA CIP-evolved planktonic and PAO1 CIP biofilm and planktonic populations.We identified mutator populations in the CIP-evolved lineages of Δ KatA populations (mutation rates to rifampicin: 1.8 E-6) due to inactivation of mutL gene.Genetic analysis revealed that a higher mutagenesis was resulted in Δ katA evolved populations especially in biofilms treated with CIP in comparison to PAO1 evolved populations.Common evolutionary trajectories were detected between the different lineages with mutations in known CIP resistance determinants and different mutational events in each growth condition. Conclusion:In conclusion, our data show the importance of the oxygen in the increased mutagenesis in biofilm resulting in the acceleration of emergence of antibiotic resistance.These results provide a framework for the dynamics and genetic mechanisms underlying the evolution of antibiotic resistance under oxidative stress in which can be similar to the environment inside the cystic fibrosis lungs.

Streamlining the diagnosis of lung cancer is pivotal to improving outcomes and thereby the quality of the patient journey. As part of this, in 2014 Liverpool introduced the concepts of “straight to CT” (where patients with suspicious imaging or symptoms have a directly arranged rapid [<72 hours] CT scan), and also the “virtual assessment” service (where those with scans suggestive of lung cancer are contacted by a lung CNS and the initial clerking and investigation planning is made by telephone) into its lung cancer diagnostic pathway This pathway is now in its 5th year and we report our experience. As regards “straight to CT”, there has been no increase in the demand for outpatient scan capacity for suspected lung cancer (about 400 scans per year). Patients with scans arranged in primary care without suspicious changes remain in the community, but those with other changes can be referred to a general chest clinic (21%). Of those who enter the virtual assessment pathway, 81% are diagnosed with lung cancer. To date, approximately 1200 patients have been through the “virtual assessment” service. Audit has shown that 98% prefer telephone assessment rather than physical clinic attendance, and most wish to be called on the same day as the scan. Patients feel that they had been given correct and timely information and feedback from primary care colleagues is uniformly positive. Lung CNS job satisfaction has improved since skills are now focussed more appropriately. Although the cancer unit diagnoses about 400 cases per year, using the virtual working model means that on average only 7 physical patient clinic attendances per week are necessary to provide the service, thereby greatly reducing resource use, saving 40% of costs overall. Furthermore, the more efficient service easily exceeds the 14 and 62 day cancer targets (99% and 97% respectively). Many lung cancer services are now moving towards “straight to CT” and virtual working models. Our experience is positive, and we would recommend its adoption.

The Liverpool Healthy Lung Project (LHLP) is a prospective screening cohort which recruits ever-smokers or subjects with COPD aged 58-75 with a lung cancer risk of ≥5% in 5 years by the LLPv2 model. It aims to identify lung cancers at a treatable stage. On chest computed tomography scans, it is common to detect incidental findings with the frequency ranging 36% - 55%, but most of them are minor findings requiring no further management. Thus, it is presumed to be cost-effective if the most significant incidental findings are managed as appropriate in lung cancer screening programmes. In the LHLP, radiologists alert a significant incidental finding (SIF, not relevant to suspicious lung cancer or indeterminate lung nodule) in the radiological reports if the Radiologist considers an urgent intervention is required; it's referred to a specialist or general practitioner outside the project. This paper reviewed the alerted reports with SIFs and followed up their final diagnosis and corresponding interventions in three hospital clinical databases. Among a total of 3336 eligible participants who have completed the baseline scans during Apr 2016 - Feb 2019, 124 SIFs have been identified in 122 individuals (3.7%). The most frequently reported SIFs at baseline are possible extra-pulmonary cancers (45 of 124, 36.3%), followed by lung infections (39 of 124, 31.5%) which often need (post-antibiotic) follow-up to confirm resolution. Nine extra-pulmonary malignancies (7.4% in SIFs, 0.3% in the LHLP) have been pathologically or radiologically confirmed, including 5 lymphomas/leukaemias (4.1%), 2 renal cancers (1.6%), 1 breast cancers (0.8%) and 1 liver metastasis with unknown origin (0.8%). Two lymphoma/leukaemia patients have been treated with chemotherapy and/or radiotherapy, and the other three are currently under active monitoring. Both of the two renal cancer patients have undergone laterally radical nephrectomy, without recurrence in 6 and 20 months after surgery, respectively. The remaining two established cancer patients are still under further investigation. Other common SIFs included 14 interstitial lung diseases (11.3%), three of which have progressed during a post-baseline follow-up time of 6 months - 2 years, and 10 aneurysms/dilated aortas (8.0%), of which two patients have undergone surgical repair and another one has commenced a preventive therapy of statin and anti-plate agent. Identification by radiology of these SIFs in 3.7% of our screened population facilitates urgent clinical review, and appropriate management of these important, but unexpected findings.

Introduction: The significant increase in the survival for Cystic Fibrosis (CF), demands the evaluation and improvement of transition processes to adulthood.Objectives: To describe the experience of this transition process in patients with CF at the Hospital Infantil Universitario de San José (HIUSJ) in Bogotá.Methods: Qualitative research with a phenomenological approach.It was carried out through semi-structured interviews to patients and their caregivers, which were transcribed and systematized with the NVIVO program, that allowed us to identify deductive and inductive categories.A methodological triangulation was used to confront the voices of the participants, the investigators group opinions and the theory.Results: Fourteen interviews were conducted, 7 to patients and 7 to their caregivers.The age ranged between 19 and 23 years old, prevailing female patients (5/7).All of the caregivers were mothers between 42 and 61 years old.The study found difficulties in understanding the disease and in the skills for its management.A strong dependence of adolescents towards their mothers was identified in the administrative procedures, visits to the clinic and treatment adherence, perceiving overprotection from caregivers that resist giving more autonomy to patients.A passive attitude towards the disease is therefore encouraged affecting the patients' communication skills, self-care and self-defense.These processes have led patients not to assume the disease, and in some cases to hide it, which shows difficulties in social skills that hinder the development of stable relationships.Conclusion: In the HIUSJ CF program, difficulties are detected in the transition to adulthood in the aforementioned skills, which can negatively impact the illness development and the quality of life and could be mitigated with early interventions, encouraging the development of this skills.

Background It is considered that early intervention of the clinical significant unexpected findings (UFs) would have a major impact on patients' health. However, how to best differentiate the level of significance of these UFs requires further investigation. Methods The radiological reports for the Liverpool Health Lung Project (LHLP) were captured as part of the NHS clinical reporting system. Radiologists flag an alert to a UF if it is considered to pose a significant adverse health impact (namely alerted UFs [AUFs]). In addition, we also used the term 'potentially significant UFs (PUFs)' which is commonly used in other studies and defined as incidental findings requiring further follow-up or evaluation. The diagnostics, outcomes and related adverse events of the PUFs and AUFs were followed up for the LHLP to 30 May 2019. The attitudes towards the reporting of UFs were also investigated. Results From Apr 2016 to Mar 2019, 3486 participants have undergone baseline LDCT screening, of which 319 had a repeat CT scan. 130 patients (3.7%) had 132 AUFs, and another 207 patients (6.0%) had 213 extra PUFs (Table below for the outcomes of the AUFs). Seventeen malignancies were diagnosed in total (14 in the AUFs and 3 in the PUFs), including 13 (0.37%) extra-pulmonary and four pulmonary cancers. Only two patients experienced postoperative complications in the PUF group. Two out of the ten deaths died from AUF-related causes. Conclusion Radiologists have an important role in reporting, interpretation and communication of incidental findings in lung cancer CT screening projects. The clinical findings identified in the AUF group had a significant clinical impact; however, the PUF findings need to be reassessed.

The Liverpool Healthy Lung Programme (LHLP) is an initiative aimed at improving respiratory health and diagnosing respiratory disease at a more treatable stage, taken by the Liverpool Clinical Commissioning Group (CCG) working with communities across Liverpool. Liverpool has one of the highest respiratory morbidity rates in England, with double the national lung cancer incidence, particularly in lower socioeconomic groups. The Liverpool Healthy Lung Programme was initiated in response to both the clinical problem and the health inequality. General practice records targeted ever-smokers and subjects with chronic obstructive pulmonary disease (COPD), 58-70y and were invited for 45-minute lung health check. Positive lifestyle messages were promoted; 5-year personal lung cancer risk calculated (www.MyLungRisk.org using LLPv2 risk model). Those who trigger the 5% threshold were offered a LDCT-scan. Spirometry was used to assess lung function (FEV1/FVC); those with abnormal results referred for potentially definitive diagnosis of COPD. Smoking advice and referrals to smoking cessation clinics were provided. Patients CT detected nodules were managed, based on BTS guidelines; referred to MDT for work-up and significant other findings (SoF) were analysed in detail. 3,591 Healthy Lung Programme consultations (consented). 11,526 people were invited, 4,566 (40%) attended. 1,853 (52%) were male, 2,897 (81%) in the most deprived IMD quintile. 832 (23%) subjects had an existing diagnosis of COPD and 527 (15%) had a previous diagnosis of cancer. 1,173 (33%) subjects had a family history of cancer. 1,548 (99.3% meeting LLPv2 5% risk criterion) were offered CT scan. 119 (9%) patients required further investigations (follow-up CT scan at 3 or 12 months, or immediate MDT referral), 25 (1.9% undergoing CT scan) were diagnosed with lung cancer (11 have suspected lung cancer, undergoing further investigations). Analysis of a sub-set of the SoF findings were followed up and indicated benefit to participants. The results suggest that it is feasible to achieve similar clinical outcome benefits to those observed in the US trial of LDCT screening for lung cancer, with lesser harms in terms of unnecessary diagnostic activity. However, this needs confirmation with extended follow-up, larger numbers of lung cancers diagnosed, and the addition of mortality data. Additional randomised trial results would also add to the precision of estimation of benefits and harms, in particular mortality results from the large European trial, NELSON. In the meantime, the results of LHLP suggest that it is succeeding in early detection of both COPD and lung cancer.