Draft Recommendation Statement
Don’t Screen for COPD in Asymptomatic Adults, Says USPSTF
November 22, 2021, 12:56 p.m. News Staff — On Nov. 2, the U.S. Preventive Services Task Force posted a draft recommendation statement and draft evidence review on screening for COPD on its website.
Based on the available evidence, the task force recommends against screening for COPD in asymptomatic adults. This is a “D” recommendation and pertains only to adults who do not recognize or report respiratory symptoms. It does not apply to individuals who present with symptoms such as chronic cough, sputum production, wheezing or difficulty breathing.
The task force also noted that its evidence review did not include people with alpha-1 antitrypsin deficiency, a hereditary genetic disorder that may cause lung damage and thereby increase the risk for COPD.
“Although COPD can eventually lead to serious breathing problems, people without signs or symptoms should not be screened for COPD because it does not improve their health or save lives,” said Chien-Wen Tseng, M.D., M.P.H., M.S.E.E., professor and associate research director in the Department of Family Medicine and Community Health at the University of Hawaii John A. Burns School of Medicine and a member of the task force, in a USPSTF news bulletin. "Treatment focuses mainly on symptoms, so there is little benefit in screening for COPD in people who do not yet have symptoms.”
According to the CDC, COPD affects almost 16 million Americans, although the agency suggests that the actual number of people with the disease may be higher. Chronic lower respiratory disease, a group of conditions composed primarily of COPD, is the fourth leading cause of death in the United States. The prevalence of COPD is highest in multiracial non-Hispanic and Native American/Alaska Native populations but is also elevated in women, people 65 and older, current and former smokers, and those with a history of asthma or childhood respiratory tract infections.
Update of Previous Recommendation
The current draft recommendation reaffirms the USPSTF’s 2016 D recommendation statement on the topic, which the AAFP supported at the time.
Story Highlights
For the current recommendation, the task force commissioned a reaffirmation evidence update. The task force explained in the draft recommendation that the purpose of this type of update is to identify whether new and substantial evidence has been published since the previous review that would be sufficient to change the prior recommendation.
In this instance, the reaffirmation update focused on targeted questions about the benefits and harms of screening for COPD in asymptomatic adults and treatment in screen-detected or screen-relevant adults. Nonpharmacologic interventions represented a new treatment modality that was evaluated in the review.
Results
Based on foundational evidence, the task force determined that externally validated questionnaires that assess risk factors, symptoms or both and that are applicable to primary care settings in the United States (e.g., the COPD Diagnostic Questionnaire and the Lung Function Questionnaire) had high sensitivity but poorer specificity for detecting COPD. Sensitivity for these questionnaires ranged from 67% to 90%, whereas specificity ranged from 25% to 73%.
Evidence evaluating the accuracy of pulmonary function tests alone to detect COPD was limited, task force members noted.
Regarding the benefits of early detection, the USPSTF found no new 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 noted that while there are no completed studies that have evaluated the effectiveness of screening or active case finding for COPD (a process that involves systematically assessing for symptoms and/or risk factors and performing spirometry) on patient health outcomes, evidence from several studies not included in the review suggest that active case finding can identify some people not yet diagnosed with COPD.
With regard to treatment, although no trials conducted in asymptomatic populations were found, the task force reviewed three trials with newly published analyses that evaluated pharmacologic treatments such as long-acting beta agonists, long-acting muscarinic antagonists and inhaled corticosteroids in individuals with mild to moderate COPD and varying levels of symptoms. Results from two trials found that LABAs, LAMAs, inhaled corticosteroids or the combination of LABAs and inhaled corticosteroids reduced COPD exacerbations or clinically important deterioration in those with fairly symptomatic moderate COPD. The task force stated that this evidence, while consistent with the previous evidence review, may not be generalizable to asymptomatic individuals.
The task force also reviewed 13 new trials that evaluated nonpharmacologic interventions such as education on COPD care, lifestyle modifications, supervised exercise programs and tobacco cessation for mild to moderate COPD. Overall, no consistent benefit was observed across a range of outcomes in observation periods ranging from 26 weeks to 104 weeks.
Overall, there was very limited evidence on the harms of pharmacologic and nonpharmacologic interventions in the treatment of mild to moderate or minimally symptomatic COPD. In general, the task force stated that these harms were not consistently reported in treatment trials, although evidence from some large observational studies suggests there may be harms associated with initiation of LABAs or LAMAs or use of inhaled corticosteroids in those with COPD.
Comment Period Open
The task force is accepting public comments on the draft recommendation statement and draft evidence review until 11:59 p.m. EST on Dec. 6. All comments will be considered as the USPSTF prepares its final recommendation.