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April 5, 2016

Screening for Chronic Obstructive Pulmonary Disease

JAMA. 2016;315(13):1419. doi:10.1001/jama.2016.3322

The US Preventive Services Task Force (USPSTF) has published updated recommendations on screening for chronic obstructive pulmonary disease (COPD).

What Is Chronic Obstructive Pulmonary Disease?

Chronic obstructive pulmonary disease is a serious lung disease that affects the ability to breathe. In people with COPD, the airways inside the lungs are damaged and narrowed, causing problems with airflow in and out of the lungs. Common symptoms of COPD include shortness of breath, wheezing, and coughing. Two types of COPD are chronic bronchitis and emphysema. Asthma is another type of obstructive lung disease that has some overlap with COPD, but unlike asthma, lung changes that happen in COPD are not reversible. The most common cause of COPD is smoking, and the best way to prevent COPD in people who smoke is to stop smoking. The April 5, 2016, issue of JAMA contains the updated USPSTF recommendations about screening for COPD.

What Tests Are Used to Screen for COPD?

Screening for COPD can be done with a questionnaire about COPD risk factors, which, if it shows a high risk of COPD, is followed by diagnostic testing with spirometry. Spirometry tests for how well the lungs work by measuring how much air is inhaled and exhaled and how quickly it is exhaled, both before and after treatment with a type of inhaled medication called a bronchodilator. Another option is to do screening spirometry without a bronchodilator, followed by diagnostic spirometry if the screening test result is abnormal.

What Is the Patient Population Under Consideration for Screening for COPD?

The USPSTF recommendation applies to adults who do not have any signs or symptoms of breathing problems. It does not apply to adults who may need preoperative testing for lung disease because they have a high risk of lung complications related to surgery.

What Are the Potential Benefits and Harms of Screening for COPD?

There are currently no studies on the benefits and harms of finding COPD in people who do not report symptoms of the disease. In people with known COPD, there is evidence that treatment with inhalers decreases COPD exacerbations (symptom flares). However, even in people with known COPD, studies have not shown consistent benefits of treatment on mortality or quality of life. Potential harms of treatment include side effects from using inhaled medications, although these are generally mild. Another factor is the time and cost of conducting both screening and diagnostic spirometry.

How Strong Is the Recommendation to Screen for COPD?

Given the lack of evidence on the effects of screening in adults with no symptoms of COPD on health outcomes, the USPSTF has concluded that there is no net benefit to screening for COPD.

Bottom Line: Current Recommendation for Screening for COPD

The USPSTF concludes that screening for COPD is not recommended in adults who do not have symptoms suggestive of COPD (called a “D” statement).

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab. A Patient Page on diagnosis and treatment of COPD was published in the September 26, 2012, issue of JAMA.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Source: US Preventive Services Task Force. Screening for chronic obstructive pulmonary disease: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2016.2638.

Topic: Preventive Medicine