https://immattersacp.org/weekly/archives/2016/04/12/4.htm

Task Force recommends against screening for COPD

The recommendation applies to asymptomatic adults, defined as those who do not recognize or report respiratory symptoms.


The U.S. Preventive Services Task Force reaffirmed its recommendation last week against screening asymptomatic adults for chronic obstructive pulmonary disease (COPD).

To update its 2008 recommendation on this topic, the Task Force reviewed evidence on whether health outcomes in asymptomatic adults are improved by COPD screening, as well as the diagnostic accuracy of screening tools. It also looked at whether delivery and uptake of preventive services are improved by COPD screening and the evidence on possible harms of screening for and treating mild to moderate COPD. The recommendation and its accompanying evidence review were published online April 5 by JAMA.

Based on its review, the Task Force recommended against screening for COPD in asymptomatic adults. This was a D recommendation, meaning that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Asymptomatic adults were defined as those who do not recognize or report respiratory symptoms. The recommendation does not apply to at-risk patients who present to clinicians with such symptoms as chronic cough or sputum production or to those with a family history of alpha1-antitrypsin deficiency.

The authors of an accompanying editorial pointed out that the Task Force's report encouraged active COPD case-finding in patients with risk factors and said that more research is needed on that point, since the effect of such case-finding on health outcomes and expenditures is unknown.

“Additional investigation is required to develop innovative formats to identify persons with undiagnosed yet more severe COPD, or risk of developing severe airflow obstruction, that may be amenable to available treatments. Prospective examination of the benefit of such case-finding approaches on health care delivery and clinical outcomes is vital,” the editorialists wrote. “Furthermore, if future therapies are developed that alter natural history and long-term health outcomes of ‘early’ or ‘mild’ COPD, the use of case-finding or even screening approaches may need to be reconsidered.”