Screening for Chronic Obstructive Pulmonary Disease

Abstract

IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the US.OBJECTIVE To conduct a targeted systematic review to update the evidence on the effectiveness of screening for COPD and the treatment of COPD to inform the US Preventive Services Task Force (USPSTF) update of the 2016 recommendation statement on COPD screening.

Screening for Chronic Obstructive Pulmonary Disease

“…The USPSTF reviewed the evidence for 3 key questions that formed the basis for their recommendation. 6 The first question was whether screening for COPD improves healthrelated quality of life or reduces morbidity or mortality. No trial has been performed that directly answers this question.…”

“…The current Evidence Report concluded that pharmacotherapy for COPD reduces exacerbations in patients with symptomatic moderate COPD, but this benefit may not be generalizable to patients with asymptomatic or mildly symptomatic COPD detected by screening. 6 The task force noted that most treatment trials of moderate airflow obstruction included participants with a mean forced expiratory volume in 1 second (FEV 1 ) of around 60% predicted. The USPSTF Evidence Report found no consistent benefit of nonpharmacologic interventions for mild to moderate COPD.…”

“…While the recommendation of the USPSTF is reasonable, based on currently available data, so is its call for further research to fill the gaps in knowledge regarding potential benefits of COPD screening or case-finding. 6 The number of adults with screen-relevant COPD is not trivial. The USPSTF has confined its review of the benefits of treating COPD to outcomes among patients with mild to moderate airflow obstruction; however, in some international studies a substantial proportion of those who screen positive have severe airflow obstruction.…”

“…In 2016, the US Preventive Services Task Force (USPSTF) reviewed this question and concluded that there was no evidence that screening for COPD in asymptomatic adults resulted in improved clinical outcomes . In this issue of JAMA , the USPSTF presents an updated Recommendation Statement on screening for COPD, based on an updated evidence report and systematic review that involved evaluation of studies published in the 6 years since the prior review . The USPSTF has arrived at the same conclusion as in 2016: “The USPSTF recommends against screening for COPD in asymptomatic adults (D recommendation).” A D recommendation indicates that the USPSTF recommends against a service, either because there is moderate or high certainty that it provides no net benefit or because the harms outweigh the benefits.…”

“…The USPSTF analyzed data from clinical trials published since its 2016 review and again found that the evidence of benefit of treating COPD at the milder end of the severity spectrum was not sufficiently robust to support screening. The current Evidence Report concluded that pharmacotherapy for COPD reduces exacerbations in patients with symptomatic moderate COPD, but this benefit may not be generalizable to patients with asymptomatic or mildly symptomatic COPD detected by screening . The task force noted that most treatment trials of moderate airflow obstruction included participants with a mean forced expiratory volume in 1 second (FEV 1 ) of around 60% predicted.…”