Task force sees no benefit of screening in asymptomatic individuals
The U.S. Preventive Services Task Force (USPSTF) has issued a final recommendation statement on screening for chronic obstructive pulmonary disease (COPD). The task force found no benefit of screening in persons without respiratory symptoms and recommends against screening for COPD in asymptomatic adults. The statement was published in the April 5 online issue of the Journal of the American Medical Association (JAMA).
In the United States, approximately 14% of adults 40 to 79 years of age have COPD, which is the nation’s third leading cause of death. Persons with severe COPD are often unable to participate in normal physical activity because of deterioration of lung function.
To update its 2008 recommendation on screening for COPD in asymptomatic adults, the task force reviewed the evidence on whether screening for COPD in asymptomatic adults (those who do not recognize or report respiratory symptoms) improves health outcomes. The USPSTF reviewed the diagnostic accuracy of screening tools (including prescreening questionnaires and spirometry);whether screening for COPD improves the delivery and uptake of targeted preventive services, such as smoking cessation or relevant immunizations; and the possible harms of screening for and treatment of mild-to-moderate COPD.
The USPSTF found no studies that directly assessed the effects of screening for COPD in asymptomatic adults on morbidity, mortality, or health-related quality of life. The task force also found no studies that examined the effects of screening on relevant immunization rates.
The USPSTF examined the treatment efficacy of four classes of medications used to treat COPD: long-acting beta-agonists (LABAs), inhaled corticosteroids, long-acting anticholinergics (tiotropium), and combination therapy with corticosteroids and LABAs. No trials were conducted in asymptomatic or screen-detected populations; all were conducted in populations with moderate COPD. Two studies of LABAs found no difference in all-cause mortality but noted decreased exacerbation of COPD symptoms in the treatment groups compared with the control groups in a post hoc analysis. Six trials of inhaled corticosteroids found decreased exacerbation of COPD symptoms but no difference in all-cause mortality, dyspnea, or quality of life.
Potential harms of treatment include pneumonia with the use of LABAs and inhaled corticosteroids, and decreased bone density and increased fractures with the use of inhaled corticosteroids. However, the study data were sparse, and there were no differences between the intervention and control groups.
The potential harms of using prescreening questionnaires and screening spirometry are false-positive and false-negative results. The USPSTF found no evidence to estimate the short- or long-term harms of these screening tests.
Similar to its 2008 findings, the USPSTF determined that there is no clinical evidence to support screening for COPD in asymptomatic persons, or that screening improves morbidity, mortality, or health-related quality of life. The task force also found that early detection of COPD, before the development of symptoms, does not alter the course of the disease or improve patient outcomes.
The task force concluded that screening for COPD in asymptomatic persons has no net benefit.
Sources: USPSTF(link is external); April 5, 2016; and JAMA(link is external); April 5, 2016.
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