Screening for Chronic Obstructive Pulmonary Disease

A 38-year-old woman presents as a new patient for a wellness visit. She has a history of hypertension that is well controlled with lisinopril, is overweight with a body mass index of 26 kg/m², and has smoked one pack of cigarettes per day for the past 15 years. She does not report having headaches, chest pain, wheezing, cough, or shortness of breath. The remaining review of systems is negative. Vital signs and physical examination results are normal.

1. According to the US Preventive Services Task Force (USPSTF) recommendation statement on screening for chronic obstructive pulmonary disease (COPD), which of the following are recommended for this patient?

• A. Screen her for COPD due to her smoking history.
• B. Counsel her about smoking cessation and offer pharmacotherapy to help her quit smoking.
• C. Do not screen her for COPD because she has not smoked one pack of cigarettes per day for 20 years or more.
• D. Do not screen her for COPD because she is not reporting any symptoms.

2. The patient wants to know whether being screened for COPD would benefit her because she smokes. According to the USPSTF recommendation statement, which one of the following describes how she should be counseled?

• A. Screening would benefit her because early COPD diagnosis leads to better outcomes.
• B. Screening would benefit her because there are no harms associated with screening.
• C. Screening would benefit her because treatments can cure COPD.
• D. Screening would not benefit her because treatments focus on reducing symptoms, so there is little benefit in detecting COPD in patients who do not yet have symptoms.
• E. Screening would not benefit her because COPD is reversible if she stops smoking.

3. According to the USPSTF recommendation statement, which one of the following best describes disparities in COPD epidemiology?

• A. Prevalence of COPD is highest in Native American and Alaska Native populations, likely due to the effects of socioeconomic challenges and high smoking rates.
• B. Black adults have higher hospitalization and mortality rates compared with White adults.
• C. The number of COPD-related deaths is higher in women than men.
• D. The number of COPD-related deaths in men is trending upward.
• E. White adults have the lowest COPD-related mortality rates.

1. The correct answers are B and D. The USPSTF recommends against screening for COPD in asymptomatic patients regardless of smoking history. This is a grade D recommendation.¹ Clinicians can help reduce patients' risk for COPD by helping them quit smoking through smoking cessation counseling, medication, or both.^2–4
2. The correct answer is D. The USPSTF found inadequate evidence that screening and treatment for COPD in asymptomatic adults reduce morbidity or mortality or improve health-related quality of life. Pharmacotherapy may marginally reduce symptoms in adults with fairly symptomatic moderate COPD, therefore detecting COPD in patients who do not yet have symptoms has little benefit.^1,5 There is no cure for COPD nor is it reversible, even if a patient stops smoking. Opportunity costs are associated with screening asymptomatic patients, such as taking time away from other critical preventive services like tobacco cessation counseling.¹
3. The correct answer is A. Prevalence of COPD is highest among Native American and Alaska Native populations, likely due to disproportionate socioeconomic challenges and health risk behaviors such as smoking. Mortality rates from chronic lower respiratory disease (mostly COPD) are highest in White adults, followed by Native American and Alaska Native adults.