COPD Continues to Present Screening Challenges, Research Barriers
Many patients with COPD do not receive a formal diagnosis until their disease is in an advanced stage.
According to the US Centers for Disease Control and Prevention, chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, and a study published in 2015 found that 15.7 million Americans had been diagnosed with COPD (per self-report).1,2 However, because many patients are unaware that they have COPD before diagnosis, the actual prevalence is believed to be much greater.
No Routine Screening
Although delayed diagnosis leads to worse symptoms and steeper healthcare costs, the US Preventive Services Task Force has recommended against routine screening for COPD using spirometry.3 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) continues to support this position in their most recent report on the diagnosis, management, and prevention of COPD.4 A paper published in JAMA summarized the screening recommendations from the updated GOLD report.5
In studies investigating pulmonary function screening, the sensitivity was found to be only 50%, and no data have demonstrated improved mortality, morbidity, or quality of life as a result of screening asymptomatic individuals.3 This “lack of evidence comes more from an absence of studies than from the presence of negative studies,” wrote the authors of the JAMA paper.
One research barrier is that COPD progresses so slowly that studies of a very long duration would have to be conducted to assess outcomes in this population adequately, according to Frank C. Sciurba, MD, associate professor of medicine at the University of Pittsburgh School of Medicine, and medical director of the Pulmonary Physiology Laboratory in the Division of Pulmonary, Allergy and Critical Care Medicine there .
Indications for Spirometry Screening
Although general screening for COPD in asymptomatic individuals is not recommended, screening is recommended in patients with symptoms and known risk factors. In those ≥40 years of age, a smoking history of >20 pack-years and recurrent symptoms such as chronic dyspnea or cough with sputum production, screening using postbronchodilator spirometry demonstrated a sensitivity of 80% and a specificity of 95% for a cutoff of less than 0.70.3
Lung cancer assessment using low-dose computed tomography is now recommended for current smokers and former smokers (within the previous 15 years) with a history of ≥30 pack-years. It is essential that this testing be performed “at experienced centers that know how to follow up on those little lung ditzels,” Dr Sciurba emphasized.
α1-Antitrypsin Deficiency Testing
The GOLD guideline recommends α1-antitrypsin deficiency testing in all patients diagnosed with COPD and their relatives, especially in regions of the world with a high prevalence of this deficiency, including Northern Europe, Spain, and Portugal. “In patients who have known COPD, one thing we can treat is α1-antitrypsin deficiency,” Dr Sciurba told Pulmonology Advisor. When detected in patients with COPD, the decline in lung function can be reduced through α1-antitrypsin augmentation therapy.4,6