Screening, Case-Finding, and Outcomes for Adults With Unrecognized COPD

Chronic obstructive pulmonary disease (COPD) is a common chronic disease of middle-aged and older adults, with an estimated prevalence of diagnosed COPD of almost 14 million individuals in the United States. 1 This condition leads to substantial morbidity, disability, impaired quality of life, increased health care costs, and mortality. 2In addition to persons with diagnosed COPD, it has been estimated that 60% of individuals living in the United States with obstructive lung disease have not been diagnosed 3 ; these individuals appear to experience impaired health status, 4 activities of daily living, 4 and outcomes. 3t is understandable that COPD, which has been defined as "a common preventable and treatable disease… characterized by persistent airflow limitation that is usually progressive," 2 may remain unrecognized.The irreversible airflow obstruction (ie, airflow obstruction that persists after inhalation of an inhaled bronchodilator) develops gradually over many years.A person with only mild airflow obstruction may truly be asymptomatic, especially if a sedentary lifestyle does not include vigorous exertion that might provoke dyspnea.A person with moderately advanced airflow obstruction might attribute gradually reduced exercise tolerance, such as dyspnea climbing stairs, to growing older or being "out of shape" and might not seek medical attention or think to mention reduced exercise tolerance to a physician seen for other reasons.In this context, the US Preventive Services Task Force (USPSTF) has undertaken a thorough systematic review 5 to update its 2008 report, assessing published evidence on the benefits and risks of screening for COPD among asymptomatic adults.This Evidence Report, 5 which supports the USPSTF Recommendation Statement, 6 both of which are published in this issue of JAMA, considers the accuracy of various screening tools, including screening questionnaires and prebronchodilator spirometry; whether screening for COPD improves the delivery and uptake of targeted preventive services or leads to benefits in terms of morbidity, mortality, or health-related quality of life; and the possible harms of screening for and treatment of mild to moderate COPD.This review and synthesis of the available evidence leads the USPSTF to recommend "against screening for COPD in asymptomatic adults" and to classify this as a D recommendation, indicating that "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits." 7The USPSTF notes that this recommendation applies only to asymptomatic adults who do not recognize or report respiratory symptoms to their clinician.Critical