Screening asymptomatic adults for COPD using spirometry—A good idea or not?

Article 1

Description

New US Preventive Services Task Force (USPSTF) recommendation about screening for chronic obstructive pulmonary disease (COPD) using spirometry.

Methods

The USPSTF weighed the benefits (prevention of>or=1 exacerbation and improvement in respiratory-related health status measures) and harms (time and effort required by both patients and the health care system, false-positive screening tests, and adverse effects of subsequent unnecessary therapy) of COPD screening identified in the accompanying review of the evidence. The USPSTF did not consider the financial costs of spirometry testing or COPD therapies.

Recommendation

Do not screen adults for COPD using spirometry. (Grade D recommendation).

Article 2

Background

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24 million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease.

Purpose

To summarize the evidence on screening for COPD using spirometry for the US Preventive Services Task Force (USPSTF).

Data sources

English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles.

Study selection

Explicit inclusion and exclusion criteria were used for each of the 8 key questions on benefits and harms of screening. Eligible study types varied by question.

Data extraction

Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.

Data synthesis

Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general US population. Spirometry has not been shown to independently increase smoking cessation rates. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy. Data on the prevalence of airflow obstruction in the US population were used to calculate projected outcomes from screening groups defined by age and smoking status. Limitation: No studies provide direct evidence on health outcomes associated with screening for COPD.

Conclusion

Screening for COPD using spirometry is likely to identify a predominance of patients with mild to moderate airflow obstruction who would not experience additional health benefits if labeled as having COPD. Hundreds of patients would need to undergo spirometry to defer a single exacerbation.

These articles are available free of charge on the US Agency for Healthcare Research and Quality website www.ahrq.gov/clinic/uspstf/uspscopd.htm