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USPSTF Screening Recommendations for COPD

JAMA; 2016 Apr 6; Siu, Bibbins-Domingo, et al

Publish date:

The US Preventive Services Task Force (USPSTF) has issued its final recommendation statement for the screening of chronic obstructive pulmonary disease (COPD), which recommends against screening for COPD in asymptomatic adults. (D recommendation). The statement, an update to the 2008 USPSTF recommendation on screening for COPD in asymptomatic adults, states:

• The USPSTF did not find evidence that screening for COPD in asymptomatic persons improves health-related quality of life, morbidity, or mortality.

• The USPSTF determined that early detection of COPD, before the development of symptoms, does not alter the course of the disease or improve patient outcomes.

• The USPSTF concludes with moderate certainty that screening for COPD in asymptomatic persons has no net benefits.

Citation: US Preventive Services Task Force (USPSTF). Screening for Chronic Obstructive Pulmonary Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;315(13):1372-1377. doi:10.1001/jama.2016.2638.

Commentary: COPD is characterized by an obstructive airway defect that is not fully reversible, as opposed to asthma, where the restriction of airflow reverses to normal or near normal with treatment. On spirometry, an obstructive defect is recognized by a decrease in FEV-1 along with an FEV-1/FVC ratio of less than 0.7. COPD has prevalence in the US of approximately 13% of adults, is the third leading cause of death in the US, and is the only 1 of the top 5 causes of death whose incidence has continued to rise over the last 20 years.1 The primary reason that the USPSTF recommends that screening not be done is that there is not evidence that early detection yields a benefit that is greater than waiting until the disease is manifest. That said, effective treatment is readily available, beginning with short-acting bronchodilators, then long-acting bronchodilators, combination bronchodilator/inhaled steroids, and PDE-4 inhibitors that are safe and effective. While screening is not recommended, we should be attentive to diagnosing patients who have symptoms suggestive of COPD so that they can get appropriate therapy.2 —Neil Skolnik, MD

1. Centers for Disease Control and Prevention (CDC). Chronic obstructive pulmonary disease among adults: United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61(46):938-943.

2. GOLD Guidelines for COPD. http://www.goldcopd.org. Accessed April 18, 2016.

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