Table 2: Summary of Evidence from AHRQ Review on Screening for COPD Using Spirometry*.
| Question | Studies Identified | Summary Results |
|---|---|---|
| Does screening for COPD with spirometry reduce morbidity and mortality? | 0 RCTs | No evidence identified |
| What is the prevalence of COPD in the general population? Do risk factors reliably discriminate between high-risk and average-risk populations? | Population-based surveys | Prevalence 4.5%–21.1% depending on definition of COPD |
| What are the adverse effects of screening for COPD with spirometry? | 3 small studies performed in pulmonary function laboratories | Physically safe; some false-positive test results occurred in asymptomatic people |
| Do individuals with COPD detected by screening spirometry have improved smoking cessation rates compared with usual smokers? | 8 RCTs, 2 SRs; only 2 RCTs evaluated independent motivational effect of spirometry | Spirometry did not increase smoking cessation rates; further studies may be needed |
| Does pharmacological treatment, oxygen therapy, or pulmonary rehabilitation for COPD reduce morbidity and mortality? | 43 RCTs, 10 MAs | Pharmacological treatments reduced exacerbations in those with symptomatic severe COPD and had a small effect on all-cause mortality |
| Oxygen therapy reduced mortality in patients with resting hypoxemia | ||
| Pulmonary rehabilitation improved some health status measures | ||
| None of the therapies were tested in patients with airflow obstruction who did not recognize or report symptoms | ||
| What are the adverse effects of COPD treatments? | 12 SRs | Common minor adverse effects included dry mouth, urinary retention, tachycardia, oropharyngeal candidiasis, easy bruising |
| Major adverse effects were rare | ||
| Do influenza and pneumococcal immunizations reduce COPD-associated morbidity and mortality? | 2 SRs | Influenza vaccination reduced COPD exacerbations occurring > 4 weeks after vaccination |
| Pneumococcal vaccination had no statistically significant impact on health outcomes | ||
| What are the adverse effects of influenza and pneumococcal immunizations in patients with COPD? | 2 SRs | Local reactions occurred at the injection site |
*
Abbreviations: AHRQ, Agency for Healthcare Research and Quality; COPD, chronic obstructive pulmonary disease; MA, meta-analysis; RCT, randomized controlled trial; SR, systematic review.
Source: Lin et al, 2008. (18)