Kenneth Lin, MD; Bradley Watkins, MD; Tamara Johnson, MD, MS; Joy Anne Rodriguez, MD, MPH; Mary B. Barton, MD, MPP
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.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
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
Download citation file:
Published: Ann Intern Med. 2008;148(7):535-543.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only