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Cover of Screening for Chronic Obstructive Pulmonary Disease Using Spirometry

Screening for Chronic Obstructive Pulmonary Disease Using Spirometry

Summary of the Evidence for the U.S. Preventive Services Task Force

Evidence Syntheses, No. 59

Investigators: , MD, , MD, , MD, MS, , MD, MPH, and , MD, MPP.

Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 08-05113-EF-1

Structured Abstract

Background:

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. Fewer than half of the estimated 24 million Americans with airflow obstruction have received a COPD diagnosis, and diagnosis often occurs in advanced stages of the disease.

Purpose:

To summarize the evidence on screening for COPD using spirometry for the U.S. Preventive Services Task Force (USPSTF).

Data Sources:

English-language articles identified in PubMed and the Cochrane Library through January 2007, recent systematic reviews, expert suggestions, and reference lists of retrieved articles.

Study Selection:

Explicit inclusion and exclusion criteria were used for each of the 8 key questions on benefits and harms of screening. Eligible study types varied by question. Data Extraction: Studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.

Data Synthesis:

Pharmacologic treatments for COPD reduce acute exacerbations in patients with severe disease. However, severe COPD is uncommon in the general U.S. population. Spirometry has not been shown to independently improve smoking cessation rates. Potential harms from screening include false-positive results and adverse effects from subsequent unnecessary therapy. Data on the prevalence of airflow obstruction in the U.S. population were used to calculate projected outcomes from screening groups defined by age and smoking status.

Limitation:

No studies provide direct evidence on health outcomes associated with screening for COPD.

Conclusion:

Screening for COPD using spirometry is likely to identify a predominance of patients with mild to moderate airflow obstruction who would not experience additional health benefits if labeled as having COPD. Hundreds of patients would need to undergo spirometry to defer a single exacerbation.

Contents

This report was also published in the Annals of Internal Medicine. Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2008, 148: 535-543.

Suggested citation:

Lin K, Watkins B, Johnson T, Rodriguez JA, Barton MB. Screening for Chronic Obstructive Pulmonary Disease Using Spirometry: Summary of the Evidence for the U.S. Preventive Services Task Force. Evidence Synthesis No. 59. AHRQ Publication No. 08-05113-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality, March 2008.

This report is based on research conducted by the staff of the Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland.

The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

Bookshelf ID: NBK33976PMID: 20722155

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