J Korean Med Sci.  2022 Apr;37(14):e117. 10.3346/jkms.2022.37.e117.

The Effectiveness and Harms of Screening for Chronic Obstructive Pulmonary Disease: An Updated Systematic Review and Meta-Analysis

• Choi N
• Jang S
• Yoo KH
• Rhee CK
• Kim Y

• KMID: 2528145
• DOI: http://doi.org/10.3346/jkms.2022.37.e117

Abstract

Background
This study aimed to perform meta-analyses to update a previous systematic review (SR) conducted by the US Preventive Services Task Force (USPSTF) to evaluate the benefits and harms of screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults.
Methods
MEDLINE, EMBASE, Cochrane Library, and regional databases were searched from their inception to January 2020. Studies for diagnostic accuracy, preventive services effect, treatment efficacy, and treatment harms were included.
Results
Eighteen studies were included, and twelve of these were newly added in this update. In meta-analyses, the pooled sensitivity and specificity for COPD diagnosis using spirometry were 73.4% and 89.0%, respectively. The relative effect of smoking cessation intervention with screening spirometry, presented as abstinence rate, was not statistically significant (risk ratio [RR], 1.21; 95% confidence interval [CI], 0.87–1.67) when all selected studies were pooled, but screening on smoking cessation was effective (RR, 1.58; 95% CI, 1.14–2.19) when limited to studies with smoking cessation programs that provided smoking cessation medicines or intensive counseling at public health centers or medical institutions.
Conclusion
In this study, no direct evidence for the impact on health outcomes of screening asymptomatic adults for COPD was identified similar to the previous SR. Further research is necessary to confirm the benefits of COPD screening.

Keyword

Chronic Obstructive Pulmonary Disease; Screening; Spirometry; Asymptomatic; Systematic Review

Figure

• 

  Fig. 1 Analytic framework.[KQ 1] Screening asymptomatic adults for COPD via spirometry results in improved COPD-related health outcomes (health-related quality of life or morbidity or mortality)?[KQ 2] What is the diagnostic accuracy of screening spirometry in diagnosing COPD in asymptomatic adults?[KQ 3] What are the adverse effects of screening spirometry in diagnosing COPD in asymptomatic adults?[KQ 4] Does screening spirometry for COPD to asymptomatic adults improve smoking cessation rates?[KQ 5] Does screening spirometry for COPD to asymptomatic adults improve vaccination rates?[KQ 6] Does treatment for asymptomatic mild or moderate COPD patients detected via screening spirometry improve COPD related health outcomes?[KQ 7] Does treatment for asymptomatic mild or moderate COPD patients detected via screening spirometry have adverse effects?COPD = chronic obstructive pulmonary disease.

• 

  Fig. 2 PRISMA flow chart.aRegional DB: KoreaMed, KMbase, RISS, KISS, NDSL; bFor KQ 3, meta-analysis was not conducted.

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