Screening for COPD not Worth the Cost

The United States Preventive Services Task Force (USPSTF) has released a recommendation statement saying that screening asymptomatic adults for chronic obstructive pulmonary disease (COPD) is not beneficial. The statement was published on the website of the Journal of the American Medical Association on April 5, 2016.

The USPSTF bases recommendations on the evidence of whether a particular preventive care service benefits or harms patients, but does not take cost into account. They state that clinical decisions should be made on more than evidence alone, saying, “Clinicians should understand the evidence but individualize decision making to the specific patient or situation.”

In the case of COPD, screening could consist of spirometry, or a prescreening questionnaire, or both. Spirometry is required for a definitive diagnosis.

The USPSTF says its experts “found inadequate evidence that screening for COPD in asymptomatic persons using questionnaires or spirometry improves health outcomes.” While they did not determine beneficial outcomes from screening, neither did they find harmful outcomes associated with screening. However, they added “the opportunity cost associated with screening asymptomatic persons may be large” because a significant amount of time and effort is required for a COPD screening.

Providing more detail, the USPSTF says this recommendation “does not apply to at-risk persons who present to clinicians with symptoms such as chronic cough, sputum production, dyspnea, or wheezing,” but only to asymptomatic adults. The biggest risk factor for developing COPD is exposure to cigarette smoke, and the USPSTF statement urges clinicians to “ask all adults, including pregnant women, about tobacco use and provide tobacco cessation interventions for those who use tobacco products.”

Additionally, the USPSTF found that many COPD studies do not separate results according to smoking status, leaving gaps in the research. They suggest “future studies that stratify risk by smoking status could help identify different risk groups that may benefit from screening.” They add that “trials are needed to assess the effects of screening among current and previous smokers in primary care on long-term health outcomes.”

“The USPSTF found no studies that directly assessed the effects of screening for COPD in asymptomatic adults on morbidity, mortality, or health-related quality of life,” according to the statement. In addition to the lack of research on how screening people without symptoms might impact outcomes, several other organizations have made similar recommendations. The American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society issued a joint recommendation against screening asymptomatic adults in 2011.