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Task Force recommends against screening for chronic obstructive pulmonary disease using spirometry

Adults without symptoms of chronic obstructive pulmonary disease (COPD) should not be screened for the disease using spirometry, according to a new recommendation from the U.S. Preventive Services Task Force. The recommendation and the accompanying summary of evidence are posted online in the Annals of Internal Medicine and appear in the April 1, 2008, print edition of the journal.

COPD is a lung disease in which the airways in the lungs are damaged, making it hard to breathe. COPD is the fourth leading cause of death and affects more than 5 percent of the U.S. population. Current or past cigarette smoking is the most common cause of COPD. Breathing in chemicals or other kinds of lung irritants over a long period of time may also cause or contribute to COPD, and individuals over the age of 40 are also at higher risk for the disease. Screening for COPD is most often performed using spirometry, a lung function test that uses a spirometer machine.

Spirometry is performed by having a patient breathe into a tube attached to a spirometer machine, which calculates the amount of air the lungs can hold and the rate that air can be inhaled and exhaled. The results of the test are compared with those of healthy individuals of similar height and age and of the same gender and race.

The Task Force found that the benefits of screening individuals without symptoms of COPD were very small. Approximately 400 adults between the ages of 60-69 would need to be screened in order to identify a single patient who may later develop COPD symptoms severe enough to require immediate medical care.

The Task Force also found that spirometry can substantially overdiagnose COPD in people over the age of 70 who have never smoked and can produce some false positives in younger adults. In those patients experiencing symptoms of COPD, including coughing that doesn't go away, coughing up large amounts of mucus, shortness of breath, wheezing, and chest tightness, spirometry may be used to confirm a diagnosis of COPD.

The Task Force found evidence that the diagnosis did not have an impact on the number of patients who quit smoking, nor could they find evidence that it increased the number of patients who received the flu vaccine. Quitting smoking is the single most important thing a patient can do to slow the progression of the disease, and there is some evidence that getting vaccinated against the flu can prevent worsening of COPD symptoms.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality (AHRQ), conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The Task Force recommends against screening adults for COPD using spirometry (D recommendation). The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspscopd.htm.

Editor's Note: Previous Task Force recommendations, summaries of the evidence, and related materials are available from the AHRQ Publications Clearinghouse. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov.

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