Kenneth Lin, MD; Bradley Watkins, MD; Tamara Johnson, MD, MS; Joy Anne Rodriguez, MD, MPH; Mary B. Barton, MD, MPP
Acknowledgment: The authors thank Timothy Wilt, MD, MPH, and co-investigators at the Minnesota Evidence-based Practice Center, for generously sharing data that were not yet published when this review was written. They also thank Caryn McManus and Gloria Washington at the AHRQ for technical assistance with the literature searches and compilation of data.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Kenneth Lin, MD, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Lin and Barton: Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850.
Dr. Watkins: Veterans Affairs Medical Center, 50 Irving St NW, Washington, DC 20422.
Dr. Johnson: University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201.
Dr. Rodriguez: Brooks Air Force Base, Brooks City-Base, TX 78235.
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.
Analytic framework for screening for chronic obstructive pulmonary disease (COPD) using spirometry.
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. U.S. Preventive Services Task Force Hierarchy of Research Design and Quality Rating Criteria
Appendix Table 2. Systematic Literature Reviews on Adverse Effects of Pharmacologic Therapies for Chronic Obstructive Pulmonary Disease
Appendix Table 3. Adverse Effects of Pharmacologic Treatments for Chronic Obstructive Pulmonary Disease
Table 1. Projected Outcomes of Screening 10 000 Asymptomatic Adults for Chronic Obstructive Pulmonary Disease Using Spirometry
Projected outcomes of population-based screening for chronic obstructive pulmonary disease (COPD) using spirometry in current smokers age 40 years or older.
NHANES = National Health and Nutrition Examination Survey.
Table 2. Summary of Evidence
Study flow diagram: key question 3.
COPD = chronic obstructive pulmonary disease.
Study flow diagram: key question 4.
Study flow diagram: key question 6.
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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. ;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 Airway Disease, Guidelines, Pulmonary/Critical Care.
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