Kenneth Lin, MD; Bradley Watkins, MD; Tamara Johnson, MD, MS; Joy Anne Rodriguez, MD, MPH; Mary B. Barton, MD, MPP
Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:535-543. doi: 10.7326/0003-4819-148-7-200804010-00213
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Published: Ann Intern Med. 2008;148(7):535-543.
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.
To summarize the evidence on screening for COPD using spirometry for the U.S. Preventive Services Task Force (USPSTF).
English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles.
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.
Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.
Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general U.S. 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 U.S. population were used to calculate projected outcomes from screening groups defined by age and smoking status.
No studies provide direct evidence on health outcomes associated with screening for COPD.
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.
M/M = morbidity and mortality.
Does screening for COPD with spirometry reduce morbidity and mortality?
What is the prevalence of COPD in the general population? Do risk factors reliably discriminate between high-risk and average-risk populations?
What are the adverse effects of screening for COPD with spirometry?
Do individuals with COPD detected by screening spirometry have improved smoking cessation rates compared with usual smokers?
Does pharmacologic treatment, oxygen therapy, or pulmonary rehabilitation for COPD reduce morbidity and mortality?
What are the adverse effects of COPD treatments?
Do influenza and pneumococcal immunizations reduce COPD-associated morbidity and mortality?
What are the adverse effects of influenza and pneumococcal immunizations in patients with COPD?
Appendix Table 1.
Appendix Table 2.
Appendix Table 3.
NHANES = National Health and Nutrition Examination Survey.
COPD = chronic obstructive pulmonary disease.
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