What are the United States Preventive Services Task Force (USPSTF) guidelines for chronic obstructive pulmonary disease (COPD) screening in smokers?

From the Guidelines

The USPSTF does not recommend routine screening for chronic obstructive pulmonary disease (COPD) using spirometry in asymptomatic adults, including smokers, as the benefits of screening do not outweigh the harms 1.

Key Points

• The USPSTF concludes that there is at least moderate certainty that screening for COPD using spirometry has no net benefit 1.
• Risk factors for COPD include current or past tobacco use, exposure to occupational and environmental pollutants, and older age, but even in high-risk groups, the benefits of screening are limited 1.
• The USPSTF recommends that all current smokers receive smoking cessation counseling and be offered pharmacologic therapies to increase cessation rates, regardless of the presence or absence of airflow obstruction 1.
• Spirometry can be performed in a primary care physician's office or in a pulmonary testing laboratory, but the USPSTF did not review evidence comparing the accuracy of spirometry performed in different settings 1.

Clinical Considerations

• The recommendation applies to healthy adults who do not recognize or report respiratory symptoms to a clinician, and does not apply to individuals with a family history of α1-antitrypsin deficiency 1.
• For individuals who present to clinicians with chronic cough, increased sputum production, wheezing, or dyspnea, spirometry would be indicated as a diagnostic test for COPD, asthma, and other pulmonary diseases 1.

From the Research

USPSTF Guidelines for COPD Screening in Smokers

• The USPSTF recommends against screening for COPD in asymptomatic adults, including smokers 2, 3.
• The USPSTF found no evidence that screening for COPD in asymptomatic persons improves health-related quality of life, morbidity, or mortality 2.
• The USPSTF concludes with moderate certainty that screening for COPD in asymptomatic adults has no net benefit 2, 3.
• However, the USPSTF does recommend annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years 4.

Rationale for Not 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 5.
• Hundreds of patients would need to undergo spirometry to defer a single exacerbation 5.
• Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy 5.

Diagnosis and Management of COPD

• Patients with suspected COPD should have the diagnosis confirmed with spirometry 6.
• Disease severity is based on spirometry results and symptoms 6.
• The goals of treatment are to improve quality of life, reduce exacerbations, and decrease mortality 6.