Should I be screened for COPD?

What the USPSTF recommends

The 2022 statement reaffirms the 2016 recommendation. The USPSTF concluded with moderate certainty that screening adults without symptoms has no net benefit (USPSTF 2022). It does not apply to people with a chronic cough, phlegm, shortness of breath or wheezing, and the review did not include people at very high risk, such as those with alpha-1 antitrypsin deficiency or known workplace exposures (USPSTF 2022).

Why it matters

COPD is a lasting reduction of airflow in the lungs, and severe disease can stop people from doing normal activities (USPSTF 2022). About 6% of US adults had been diagnosed with COPD in 2020. Chronic lower respiratory disease, mostly COPD, is the sixth leading cause of death in the US (USPSTF 2022).

What raises the risk

Cigarette smoking is the leading cause. About 15% of people who smoke and 8% of people who used to smoke report a COPD diagnosis, compared with 3% of adults who never smoked (USPSTF 2022). Secondhand smoke, traffic pollution and wood smoke also contribute, and fumes, dust and chemicals at work are thought to contribute to about 15% of cases. Asthma, childhood chest infections and alpha-1 antitrypsin deficiency also raise the risk (USPSTF 2022).

Why screening does not help

Screening questionnaires catch many people with COPD but also flag many who do not have it (USPSTF 2022). No studies show that screening people without symptoms improves their health or lifespan. Treatment trials were in people who already had fairly noticeable symptoms, where inhalers cut flare-ups, and no treatment trial was done in people without symptoms (USPSTF 2022). Treatment decisions are based mainly on symptoms and flare-ups, not on breathing test numbers (USPSTF 2022).

There is no cure for COPD. Avoiding cigarette smoke and other toxic fumes is the best way to prevent it, and people who smoke should be offered counseling and medicines to quit, whether or not they have COPD (USPSTF 2022).

Common questions

I smoke. Should I get a breathing test anyway?

Not as a screening test if you have no symptoms: the advice against screening includes people who smoke. If you notice a cough, phlegm, wheezing or getting out of breath, tell a clinician. Joint guidelines from physician and lung groups recommend spirometry for people with breathing symptoms and advise against it for people without them (USPSTF 2022).

How is COPD diagnosed?

With spirometry after a bronchodilator medicine. A ratio of FEV1 to FVC below 0.70 confirms lasting airway obstruction in people with symptoms and exposures (USPSTF 2022).

Also see the quit smoking help check, the lung cancer screening check, the aortic aneurysm screening check and all screening tests by age.