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Task Force Issues Draft Recommendation Statement for COPD Screening
The U.S. Preventive Services Task Force (USPSTF) has posted a draft recommendation statement on screening for chronic obstructive pulmonary disease (COPD). The statement is available for review and public comment from August 18 through September 14, 2015.
In the document, the USPSTF recommends against screening for COPD in asymptomatic adults.
Approximately 13.7 million persons in the U.S. are affected annually by COPD. As lung function deteriorates over time, patients experience significant restrictions in their ability to work and to participate in other activities of daily living. In 2013, COPD was responsible for approximately 10.3 million physician visits and 1.5 million emergency department visits. Health care costs associated with COPD are estimated at $32 billion per year.
Since a 2008 USPSTF recommendation, there is still no evidence that screening for COPD in asymptomatic individuals improves health-related quality of life, morbidity, or mortality, the task force says. The USPSTF commissioned a systematic review to examine whether screening for COPD improves the delivery and uptake of targeted preventive services, such as smoking cessation or relevant immunizations. In addition to the potential benefits of screening, the USPSTF also examined the possible harms of screening for and treatment of mild-to-moderate COPD.
The task force 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 USPSTF also found no studies that examined the effectiveness of screening on relevant immunization rates. The task force identified five studies that assessed the effects of screening on smoking cessation. These studies primarily examined the incremental value of adding spirometry testing to existing smoking-cessation programs. One trial showed a statistically significant difference in smoking-cessation rates between participants who received explanations of their spirometry results using “lung age” and those who did not. The other four trials did not report significant differences in smoking abstinence rates.
The USPSTF also examined the treatment efficacy of four classes of medications used in the treatment of COPD — long-acting beta-agonists (LABAs), inhaled corticosteroids, long-acting anticholinergics (tiotropium), and combination therapy with corticosteroids and LABAs. None of the treatment trials was 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 decreased COPD exacerbation in the treatment group compared with the control group in post hoc subanalyses. Six trials of inhaled corticosteroids found decreased COPD exacerbation but no difference in all-cause mortality, dyspnea, or quality of life. One trial of combination therapy with corticosteroids and LABAs showed decreased COPD exacerbation but no differences in mortality or quality of life. Five trials of anticholinergics found decreased COPD exacerbation but insufficient evidence on other outcomes.
For all classes of medications, the one consistent finding was that treatment decreased COPD exacerbation in persons with moderate COPD, without consistent effects on all-cause mortality, dyspnea, or quality of life. For all classes of medications, there was insufficient evidence on the effects of treatment on exercise capacity.
According to the USPSTF, the harms of prescreening questionnaires and screening spirometry are false-positive and false-negative results. The task force found no evidence to estimate the long-term harms of these screening tests. Potential harms of treatment may 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 data were sparse, with few adverse events, and there were no differences between the intervention and control groups.
Since all of the treatment trials were conducted in persons with mild-to-moderate COPD, it is unclear how these results would apply to asymptomatic populations, the task force notes. The potential treatment benefit of decreased exacerbation of symptoms may not apply to patients who report no symptoms to begin with. Given the lack of potential benefits of treatment in asymptomatic persons and the potential harms of screening, the USPSTF determined that there is no net benefit of screening.
Source: USPSTF; August 18, 2015.