Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the U.S. Preventive Services Task Force.
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.
Lin
Kenneth
K
Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA. kenneth.lin@ahrq.hhs.gov
Watkins
Bradley
B
Johnson
Tamara
T
Rodriguez
Joy Anne
JA
Barton
Mary B
MB
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