USPSTF Reaffirms Recommendation Against COPD Screening in Asymptomatic Adults

Carol M. Mangione, MD

Today, the US Preventive Services Task Force (USPSTF) commissioned a reaffirmation evidence update that indicated with moderate certainty that screening for chronic obstructive pulmonary disease in asymptomatic adults had no net benefit.

Chronic obstructive pulmonary disease is a condition defined by irreversible reduction of airflow in the lungs and was estimated to affect approximately 6% of US adults in 2020. Chronic lower respiratory disease is the sixth leading cause of death in the US.

Additionally, while age-adjusted death rates for COPD are higher in men than women, the age-adjusted death rate has been declining in men in the past 2 decades while remaining the same in women.

Previously, the USPSTF reviewed screening evidence for COPD in 2016 and issued a D recommendation against screening in asymptomatic adults.

In a recommendation statement provided by the USPSTF, Carol M. Mangione, MD, MSPH, David Geffen School of Medicine, University of California, provided details into the reaffirmation process and what the implications of this recommendation were.

Notably, the recommendation is applicable to adults who do not recognize or report respiratory symptoms, it does not apply to those who present with symptoms including chronic cough, sputum production, trouble breathing, or wheezing.

Additionally, the severity of disease relates to the degree of obstruction and/or symptoms, with airflow obstruction being classified by postbronchodilator FEV1% predicted; 80% or more is mild, 50% to 79% is moderate, 30% to 49% is severe, and less than 30% is very severe.

Though the organization doesn’t recommend screening in asymptomatic adults, factors such as cigarette smoking could increase a person’s risk for COPD. Cigarette smoking is the leading cause of COPD in the US, with approximately 15% of current smokers and 8% of former smokers reporting a diagnosis of COPD.

At the moment, there is no cure for COPD, yet prevention of smoke and toxic fume exposure is recommended. Pharmacologic therapies and nonpharmacologic therapies are available for disease management in persons with mild to moderate or minimally symptomatic COPD.

Regarding the reaffirmation of the 2016 recommendation, the USPSTF found no new studies that directly assess the effects of screening for COPD in asymptomatic adults on morbidity, mortality, or health-related quality of life.

Additionally, the organization reviewed new data form 6 treatment trials and 2 observational trials that focused on pharmacologic or nonpharmacologic treatment harms in adults with mild to moderate or minimally symptomatic COPD. Mangione noted that among the trials thar reported adverse events, no significant harms were recorded.

Overall, serious harms from treatment trials were not consistently reported, though large observational studies in screen-relevant populations suggested possible harms for long-acting muscarinic antagonists (LAMA) or long-acting beta-agonists (LABA) initiation or use of ICS.

Mangione noted that question still remain regarding the effectiveness of screening asymptomatic adults for COPD as well as the effectiveness of early treatment for asymptomatic, minimally symptomatic, or screen-detected populations to slow disease progression.

Likewise, the harms of screening are still unknown, as are the reasons for health disparities in COPD among different racial and ethnic groups andeffective prevention strategies for these populations.

“The USPSTF found no new substantial evidence that could change its recommendation and, therefore, reaffirms its recommendation against screening for COPD in asymptomatic adults,” Mangione wrote.

The statement, "Screening for Chronic Obstructive Pulmonary Disease US Preventive Services Task Force Reaffirmation Recommendation Statement," was published online in JAMA Network Open.