USPSTF continues to recommend against screening for COPD in people without signs, symptoms

The U.S. Preventive Services Task Force posted a new draft recommendation in which it continues to recommend against screening for COPD in people without signs or symptoms.

This is a D recommendation, according to the USPSTF.

This recommendation does not apply to individuals who already have signs and symptoms of COPD, those who were previously diagnosed with COPD or those with disorders that can cause COPD, according to a USPSTF press release.

The USPSTF draft recommendation statement and evidence review have been published for public comment on the USPSTF. Comments can be submitted until Dec. 6, 2021.

In 2016, the USPSTF reviewed the evidence for COPD screening in asymptomatic individuals and issued a D recommendation, indicating no net benefit. The task force then used a reaffirmation deliberation process and again concluded with moderate certainty that COPD screening in asymptomatic individuals has no net benefit, according to the draft recommendation statement.

“Although COPD can eventually lead to serious breathing problems, people without signs or symptoms should not be screened for COPD because it does not improve their health or save lives,” Chien-Wen Tseng, MD, MPH, MSEE, task force member; the Hawaii Medical Service Association endowed chair in health services and quality research; and professor and associate research director in the department of family medicine and community health at the University of Hawaii John S. Burns School of Medicine, said in the release. “Treatment focuses mainly on symptoms, so there is little benefit in screening for COPD in people who do not yet have symptoms.”

Targeted evidence review

The task force also posted a draft targeted evidence review. Researchers reviewed MEDLINE, the Cochrane Central Register of Controlled Trials and CINAHL from January 2015 to January 2021 and identified 16 trials published since the USPSTF’s recommendation in 2016. These trials included individuals with mild (FEV₁ 80% predicted) to moderate (FEV₁ 50% to 79% predicted) COPD or a mean population FEV₁ of 60% or more predicted.

No trials examined the effectiveness of screening for COPD on health outcomes. Of the 16, trials, three (n = 20,058) evaluated long-acting beta agonists, long-acting muscarinic antagonists and/or inhaled corticosteroids (ICS) and 13 (n = 3,657) evaluated nonpharmacologic interventions for COPD. The SUMMIT and UPLIFT trials reported that LABA, LAMA, ICS or LABA/ICS treatment reduced exacerbations or clinically important lung deterioration in individuals with symptomatic moderate COPD. In the UPLIFT trial, tiotropium reduced exacerbations in a subgroup analysis of individuals with minimal COPD symptoms.

“The findings of this targeted evidence update are generally consistent with the findings of the previous systematic review supporting the 2016 recommendation. To date, there are still no comparative studies on the effectiveness of screening or active case finding for COPD on patient health outcomes. The demonstrated benefits of pharmacologic treatment for COPD are still largely limited to persons with moderate airflow obstruction; and there was no consistent benefit observed for a range of non-pharmacologic interventions in mild to moderate COPD, or in minimally symptomatic persons with COPD,” the authors concluded.

Risks for COPD

Although the USPSTF recommends against screening in asymptomatic individuals, it acknowledges factors that may increase risk for COPD.

Cigarette smoking is the leading cause of COPD in the U.S. Nearly 15% of current smokers and 8% of former smokers report a diagnosis of COPD compared with 3% of nonsmokers, according to the draft recommendation statement.

“While screening for COPD is not beneficial, most cases of COPD can be prevented,” Katrina Donahue, MD, MPH, task force member; professor and vice chair of research at the University of North Carolina at Chapel Hill Department of Family Medicine; family physician and senior research fellow at the Cecil G. Sheps Center for Health Services Research; and co-director of the North Carolina Network Consortium, said in the release. “Not smoking, and quitting if you do, is the best way to prevent COPD and its negative effects on health; it is essential that clinicians help their patients who smoke to quit.”

Exposure to secondhand smoke, traffic pollutants and wood smoke are also risk factors for COPD along with toxic fumes, dust and workplace exposure chemicals, which are attributable to 15% of COPD diagnoses.

Other nonmodifiable risk factors include history of asthma, respiratory tract infections in childhood and 1-antitrypsin deficiency, according to the draft recommendation statement.

Research needs and gaps

The USPSTF highlighted research needs and gaps regarding COPD screening, which include:

• the effectiveness of COPD screening in asymptomatic individuals to reduce morbidity/mortality or improve health-related quality of life with long-term follow-up;
• the effectiveness of early COPD treatment among asymptomatic, minimally symptomatic or screen-detected individuals to slow disease progression and improve outcomes with long-term follow-up;
• harms of screening and treating asymptomatic or minimally symptomatic individuals with COPD; and
• drivers of COPD health disparities among different racial/ethnic groups and prevention strategies to improve these health inequities.

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