USPSTF finalizes recommendation against COPD screening in asymptomatic adults
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The U.S. Preventive Services Task Force finalized its recommendation against screening for COPD in asymptomatic adults, which is consistent with its 2016 recommendation.
“In 2008, and again in 2016, the U.S. Preventive Services Task Force issued a D recommendation against screening for COPD in asymptomatic adults (defined as individuals who do not recognize or report respiratory symptoms),” Elizabeth M. Webber, MS, research associate at the Kaiser Permanente Evidence-based Practice Center at the Center for Health Research in Portland, Oregon, and colleagues wrote in JAMA. “Although prior evidence demonstrated that screening could identify adults with COPD, there was no direct evidence that screening for COPD improved patient outcomes and limited treatment evidence to suggest a clinically meaningful benefit in persons considered to be most applicable to a screen-detected population.”
The final recommendation comes after a draft recommendation statement evidence review were published in November 2021 for public comment.
Recommendation against screening
The USPSTF task force evaluated MEDLINE, the Cochrane Central Register of Controlled Trials and CINAHL to identify relevant studies that screened individuals who did not recognize or report respiratory symptoms and studies of treatment in adults with mild to moderate or symptomatic COPD. All studies were published from January 2015 to January 2021.
The evidence report included three trials or analyses of pharmacologic treatment (n = 20,058), 13 trials on nonpharmacologic interventions (n = 2,657) and two large observational studies addressing pharmacologic treatment harm (n = 243,517).
Results of clinical trials of pharmacologic therapy were consistent with the 2016 USPSTF review supporting the recommendation that bronchodilators with or without inhaled corticosteroids reduce COPD exacerbations and tiotropium (Spiriva, Boehringer Ingelheim) improves health-related quality of life in adults with moderate COPD, according to the evidence review. The task force reported no consistent benefit for any nonpharmacologic intervention for COPD and no significant harms among treatment trials that reported adverse events, according to the review.
The two large observational studies demonstrated associations between initiation of long-acting muscarinic antagonists or long-acting beta agonists and risk for serious cardiovascular events among treatment-naive patients as well as an association between inhaled corticosteroid use and risk for diabetes development, according to the task force.
This finalized recommendation applies to asymptomatic adults who do not recognize or report respiratory symptoms, not to those who present with symptoms such as chronic cough, sputum production, breathing difficulties or wheezing.
“This recommendation is a reaffirmation of the USPSTF 2016 recommendation statement. In 2016, the USPSTF reviewed the evidence for COPD and found that screening for COPD in asymptomatic adults has no net benefit. The USPSTF found no new substantial evidence that could change its recommendation and, therefore, reaffirms its recommendation against screening for COPD in asymptomatic adults,” the task force wrote.
In 2011, a joint guideline from the American College of Physicians, American College of Chest Physicians, American Thoracic Society and European Respiratory Society recommended against screening for COPD with spirometry in asymptomatic adults.
Research needs, gaps
The task force highlighted several research needs and gaps, including more information on the effectiveness of asymptomatic COPD screening to reduce morbidity or mortality or improve health-related quality of life; the effectiveness of early treatment in asymptomatic, minimally symptomatic or screen-detected adults; harms of screening and treatment in this population; and drivers of COPD health disparities and effective prevention strategies.
In an accompanying editorial, Surya P. Bhatt, MD, MSPH, associate professor of medicine in the division of pulmonary, allergy and critical care medicine at the University of Alabama, Birmingham, and George T. O’Connor, MD, MS, professor of medicine in the Pulmonary Center at Boston University School of Medicine and associate editor for JAMA, wrote, “[w]hile the recommendation of the USPSTF is reasonable, based on currently available data, so is its call for further research to fill the gaps in knowledge regarding potential COPD screening or case-finding.
“Even though available data may not support screening asymptomatic adults for COPD, there is substantial rationale for further investigation of strategies to enhance earlier detection of this condition,” Bhatt and O’Connor wrote.