On April 5, the U.S. Preventive Services Task Force (USPSTF) published its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summary(www.uspreventiveservicestaskforce.org) on screening for chronic obstructive pulmonary disease (COPD), recommending against screening for the disease in asymptomatic adults.
This "D"(www.uspreventiveservicestaskforce.org) recommendation updates a 2008 recommendation from the task force that also advised against screening asymptomatic adults for COPD -- specifically, with spirometry.
The AAFP mirrored the USPSTF's final recommendation in its own updated guidance.
"The task force did not find any evidence that screening for COPD in adults without respiratory symptoms results in improved health outcomes," said USPSTF member William Phillips, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "Given the lack of benefit of early detection and the time and effort required to screen for COPD in all individuals, the task force is recommending against screening in asymptomatic people."
Update of 2008 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
When the USPSTF released its draft recommendation statement back in August, 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 USPSTF and AAFP recommended last year, 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 recommended 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.
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