USPSTF (Still) Recommends Against Screening for COPD

[[{"type":"media","view_mode":"media_crop","fid":"40963","attributes":{"alt":"USPSTF ","class":"media-image media-image-right","id":"media_crop_9799401641109","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4251","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 397px; width: 265px; float: right;","title":"©ImagePointFr/Shutterstock.com ","typeof":"foaf:Image"}}]]The United States Preventive Services Task Force (USPSTF) recently issued a draft recommendation against screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults. The draft recommendation, posted to the USPSTF’s website, is open for public comment until September 14, 2015 at 8:00 p.m.

The grade D recommendation updates the group’s 2008 recommendation statement that also advised against screening for COPD in this population. For this recommendation, the USPSTF commissioned a systematic review of research to assess if screening for COPD improved the use of targeted preventive services, including smoking cessation or relevant immunizations.  

“The USPSTF found no evidence that screening for COPD in asymptomatic persons with questionnaires or spirometry improves health outcomes,” the group wrote. “There are no data to suggest that screening for COPD before the development of symptoms affects treatment decisions, alters the course of the disease, or improves patient outcomes.”

According to the draft recommendation, the USPSTF was unable to find adequate evidence pointing to long-term harms of screening tests. The authors do note, however, that given the absence of benefit seen with early detection and treatment, the costs accrued to screen asymptomatic persons may be significant. “The amount of time and effort…” the draft document reads, “… are not trivial.”

Screening is not without potential harm, however, if it leads to unnecessary treatment. Among the potential harms of drugs used to treat COPD are pneumonia from long-acting beta-agonists or corticosteroids and decreased bone density with the use of inhaled corticosteroids.

In addition, current data show a lack of benefit for early detection and treatment of COPD and studies examining the effect of screening on smoking cessation, relevant immunizations, and quality of life are scarce.

The group clarified that its recommendations do not apply to “at-risk persons who present to clinicians with symptoms such as chronic cough, sputum production, dyspnea, or wheezing. It also does not apply to persons with a family history of alpha-1 antitrypsin deficiency.”

Given the lack of evidence of the usefulness of screening in asymptomatic adults, the USPSTF draft recommends screening of current and previous smokers for COPD in the primary care setting to gather long-term outcome data. In addition, long-term epidemiologic studies looking at the natural history of the disease’s progression may help researchers to identify patients who are at greatest risk for clinical deterioration.

The Task Force’s draft recommendation statement has been posted for public comment on the Task Force Web site at www.uspreventiveservicestaskforce.org