Adults without respiratory symptoms such as a chronic phlegmy cough or wheezing and shortness of breath don’t need routine screening for chronic obstructive pulmonary disorder (COPD), according to new guidelines from an influential U.S. medical group.
The new recommendations, issued by the U.S. Preventive Services Task Force (USPSTF), are in line with 2016 guidelines that discouraged widespread screening of people without any symptoms of COPD, a chronic progressive respiratory disease that is most often caused by smoking. People with respiratory symptoms or who are at higher risk of COPD due to genetics or workplace exposure to certain chemicals that can damage the lungs should be still get tested for the condition, the USPSTF notes in its latest recommendations, published in JAMA.
“There is no evidence that detecting and treating COPD in individuals without respiratory symptoms improves health-related quality of life or reduces mortality,” wrote Jill Jin, MD, MPH, associate editor of JAMA, in a patient page accompanying the recommendations.
“For people with mild to moderate COPD who have symptoms, treatment decreases COPD exacerbations and hospitalizations, but the effect of COPD treatment on risk of death is uncertain,” Dr. Jin notes.
More than 1 in 20 U.S. adults have COPD, the USPSTF notes. Chronic lower respiratory disease is the sixth leading cause of death in the United States, and the majority of these cases are COPD.
Smoking is the biggest risk factor for COPD, responsible for up to 90 percent of cases, according to the American Lung Association. Secondhand smoke exposure can also cause COPD, and so can workplace exposure to toxic chemicals. Far less often, COPD can be caused by a rare genetic disorder known as alpha-1-antitrypsin deficiency that impairs lung function.
While the USPSTF recommends against widespread screening for COPD in otherwise healthy individuals, it is possible to use simple screening questionnaires to identify people who are at increased risk for developing this condition due to a history of smoking or other factors, Jin points out.
If a person is at high risk, the questionnaires may be followed by a type of diagnostic testing known as spirometry, Jin notes. This measures how much air people exhale and how quickly they do it before and after they receive treatment with a bronchodilator, a medicine that makes it easier to breathe by relaxing muscles in the lungs and widening the airways.
The USPSTF recommended against screening for asymptomatic individuals because there isn’t enough evidence from clinical trials to suggest that treating people with mild to moderate airway obstruction helps them live longer or improves their quality of life.
While there also isn’t any strong evidence of harms from screening, the lack of benefit should be a deterrent, the USPSTF concludes.