According to the latest figures, about 14 percent of U.S. adults ages 40-79 suffer from chronic obstructive pulmonary disease (COPD), and the condition is the third leading cause of death in the United States. Annual health care costs associated with COPD are estimated to be about $32 billion.
The most common symptoms of COPD are dyspnea, chronic cough, sputum production and wheezing. Patients with severe disease often are unable to participate in normal physical activity because of their deteriorating lung function. Cigarette smoking is the main risk factor for the disease; more than 70 percent of people with COPD are current or former smokers.
Given the ongoing burden COPD poses on the nation's health, the U.S. Preventive Services Task Force (USPSTF) reviewed the evidence(www.uspreventiveservicestaskforce.org) on screening asymptomatic adults for the condition and released a draft recommendation(www.uspreventiveservicestaskforce.org) Aug. 17 against screening patients in whom COPD is not suspected.
"The Task Force found that there is no evidence that screening for COPD in adults without symptoms results in improved health outcomes," said USPSTF member William Phillips, M.D., M.P.H., in an Aug. 18 news bulletin.(www.uspreventiveservicestaskforce.org) "The most important step you can take to prevent COPD is to avoid smoking. People who smoke should talk with their doctors about ways to quit."
- After reviewing the most recent evidence on screening asymptomatic adults for chronic obstructive pulmonary disease (COPD), the U.S. Preventive Services Task Force released a draft recommendation against screening patients in whom COPD is not suspected.
- The task force found no evidence that screening for COPD in adults who have no symptoms of the disease results in improved health outcomes.
- Patients should be screened for tobacco use, however, says one FP expert, because smoking is associated with a number of deleterious health effects.
Update of 2008 Recommendation
This grade D recommendation(www.uspreventiveservicestaskforce.org) updates a 2008 recommendation statement(www.uspreventiveservicestaskforce.org) from the task force that also advised against screening asymptomatic adults for COPD -- specifically, with spirometry.
The AAFP mirrored this guidance with its own recommendation.
The task force 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. The group also evaluated the possible harms of screening for COPD and the diagnostic accuracy of screening tools (including prescreening questionnaires and spirometry), which was not part of the previous systematic review.
Overall, the USPSTF found no additional evidence that screening for COPD in asymptomatic patients improves health-related quality of life, morbidity or mortality since the previous recommendations were released.
Takeaways for Family Physicians
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that even though smokers have the highest risk of COPD, screening them in the absence of symptoms does not improve health outcomes.
"With all that a family physician is expected to do, we need to focus our energies on interventions that are beneficial for our patients," she said.
However, Frost said all adults should be screened for tobacco use, as the AAFP most recently recommended in 2009, because it is associated with many chronic conditions, including COPD. Helping smokers quit is the best way to prevent COPD in your practice, she added.
"Treatments for COPD help to control symptoms and improve patients' function," Frost said. "They do not 'cure' the disease. Smoking cessation is the most important treatment. Other treatments depend on the severity of the disease, but include beta agonists, anticholinergics and corticosteroids."
Frost recommends family physicians review COPD Comprehensive, an evidence-based curriculum that the Academy developed in concert with the Association of Family Medicine Residency Directors. Although it was created for family medicine residents and new-to-practice physicians, it also is valuable for established family physicians who want to brush up on their knowledge of the disease.
The USPSTF will accept comments on the draft recommendation(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence review(www.uspreventiveservicestaskforce.org) through Sept. 14.
The AAFP is reviewing the USPSTF's draft recommendation and will release its own recommendation after the task force publishes its final recommendation statement.
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