title: Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24 million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease.
  
  
  OBJECTIVE
  To summarize the evidence on screening for COPD using spirometry for the U.S. Preventive Services Task Force (USPSTF).
  
  
  METHODS
  English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles.
  
  
  METHODS
  Explicit inclusion and exclusion criteria were used for each of the 8 key questions on benefits and harms of screening. Eligible study types varied by question.
  
  
  METHODS
  Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.
  
  
  RESULTS
  Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general U.S. population. Spirometry has not been shown to independently increase smoking cessation rates. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy. Data on the prevalence of airflow obstruction in the U.S. population were used to calculate projected outcomes from screening groups defined by age and smoking status.
  
  
  CONCLUSIONS
  No studies provide direct evidence on health outcomes associated with screening for COPD.
  
  
  CONCLUSIONS
  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. Hundreds of patients would need to undergo spirometry to defer a single exacerbation.
authors.affiliation: Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA. kenneth.lin@ahrq.hhs.gov
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lin
authors.forename: Bradley
authors.initials: B
authors.lastname: Watkins
authors.forename: Tamara
authors.initials: T
authors.lastname: Johnson
authors.forename: Joy Anne
authors.initials: JA
authors.lastname: Rodriguez
authors.forename: Mary B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D000328:Adult; D006801:Humans; D007114:Immunization; D008403:Mass Screening; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D018570:Risk Assessment; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013147:Spirometry / Q000009:adverse effects