USPSTF recommends against screening for COPD

Asymptomatic adults should not be screened for chronic obstructive pulmonary disease, according to a recommendation from the US Preventive Services Task Force.

The recommendation, published in JAMA, was issued with a D grade, indicating that there is "moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits" and that physicians should "discourage the use of this service." The task force found no evidence that health-related quality of life, morbidity or mortality improved with the screening of asymptomatic adults.

With this latest recommendation, the USPSTF has updated its previous COPD recommendation, which was issued in 2008 and recommended against screening for COPD with spirometry in asymptomatic adults. The most current recommendation also includes screening questionnaires, such as the COPD Diagnostic Questionnaire (CDQ), the Lung Function Questionnaire and the COPD Population Screener.

Janelle M. Guirguis-Blake, MD, Kaiser Permanente Research Affiliates Evidence-based Practice Center and department of family medicine, University of Washington, and colleagues published their findings in an accompanying review in JAMA.

The researchers systematically reviewed 33 studies identified via MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials for the evidence report.

"There was no direct evidence available to determine the benefits and harms of screening asymptomatic adults for COPD using questionnaires or office-based screening pulmonary function testing or to determine the benefits of treatment in screen-detected populations," Guirguis-Blake and colleagues concluded. "Indirect evidence suggests that the CDQ has moderate overall performance for COPD detection. Among patients with mild-to-moderate COPD, the benefit of pharmacotherapy for reducing exacerbations was modest."

The USPSTF stated that, along with no evidence of net benefit, the cost, time and effort associated with screening asymptomatic adults was "not trivial."

They did distinguish, however, that at-risk patients, including those who present with chronic cough, sputum production, wheezing or dyspnea or those with a family history of 1-antitrypsin deficiency, are not included in the recommendation statement and should be screened and, if necessary, tested for COPD. The USPSTF did not issue a recommendation in favor of screening high-risk patients such as smokers, noting a lack of evidence stratified by smoking status.

In an accompanying JAMA editorial, Fernando J. Martinez, MD, MS, department of medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, and George T. O’Connor, MD, MS, division of pulmonary, allergy, sleep, and critical care medicine, Boston University School of Medicine, wrote that when patients present with respiratory symptoms, "clinically appropriate diagnostic testing, perhaps including pulmonary function testing, is certainly warranted."

"The distinction between persons who are truly asymptomatic and those who have symptoms they have not reported — perhaps because they have not been asked — is a challenging concept in clinical care and research," they continued.

Martinez and O'Connor hypothesized that screening smokers with spirometry, which could reveal airflow obstruction, might result in increased rates of smoking cessation. They called for additional research for COPD screening in patients with risk factors.

The USPSTF did recommend that physicians play a role in prevention and intervention, when applicable.

"The USPSTF recommends that clinicians ask all adults, including pregnant women, about tobacco use and provide tobacco cessation interventions for those who use tobacco products," they wrote. "The USPSTF also recommends that clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents."

The USPSTF cited other organizations, including the American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, the European Respiratory Chest Society and the UK National Institute for Health and Care Excellence, which also recommended against screening in asymptomatic adults. – by Chelsea Frajerman Pardes

Disclosures: Please see the full studies for a list of all authors’ disclosures.