Two Thumbs Down for COPD Screening
SOURCE: U.S. Preventive Services Task Force. Screening for chronic obstructive pulmonary disease: US Preventive Services Task Force Recommendation Statement. JAMA 2016;315:1372-1377.
Since none of the currently available pharmacologic treatments for COPD can be considered disease modifying (that is, alters the course of progression or reduces mortality), even if we were to identify COPD early, why would we have any confidence that treatment would be beneficial? Despite numerous clinical trials demonstrating improvements in lung function, activity, frequency of exacerbations, and symptoms in COPD patients, none of the medications have been able to achieve the lofty threshold of disease modifying. Only smoking cessation and oxygen at late-stage disease have been found to be disease modifying.
Upon review of the currently available evidence, the U.S. Preventive Services Task Force (USPSTF) assigned a level “D” recommendation to the issue of screening asymptomatic adults for COPD, which means, “the USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”
Within its Recommendation Statement, the USPSTF included recognition of one potentially valuable role of screening with spirometry: enhancing quit rates among smokers. But even then, results of clinical trials are mixed. Only one study that presented pulmonary status using the technique of lung age had an effect on smoking cessation rates; other studies presenting spirometry results in traditional methodology did not improve smoking cessation outcomes.
These USPSTF recommendations should not be misconstrued to reflect on the utility of spirometry for symptomatic individuals.
The U.S. Preventive Services Task Force recommends against screening asymptomatic adults for COPD.
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