Should general practitioners screen smokers for COPD?

Abstract

OBJECTIVE: To discuss whether screening for early chronic obstructive lung disease (COPD) is justifiable. BACKGROUND: The COPD diagnosis can usually be made by means of spirometry before symptoms appear. General practitioners are these days encouraged, from several quarters, to screen their smoking patients for early COPD. Smoking cessation is still the only available treatment that indisputably improves the long-term prognosis of this disease. The argument for screening is that people will be more easily motivated to stop smoking if they know their lung function results. There is, however, no documentation that this is the case. DATA SOURCES: Pub Med using the search terms "mass screening", "COPD" and "spirometry". RESULTS: There is no evidence today that spirometry screening aids smoking cessation. CONCLUSIONS: A large randomized study is needed, in which the independent effect of spirometry as part of a smoking cessation programme is studied. Until such a study has shown convincing results, and has been followed by a cost-benefit analysis in favour of screening, screening for pre-clinical COPD in general practice should not be recommended. However, it is important to diagnose people who may benefit from symptom-relieving treatment, and therefore patients with smoking-related symptoms should be offered spirometry. Finally, the general practitioner should strive to offer smoking cessation counselling to all smokers, regardless of their lung function.