IS SCREENING FOR CHRONIC OBSTRUCTIVE PULMONARY-DISEASE JUSTIFIED

Background. Many experts recommend spirometry to screen for chronic ob structive pulmonary disease (COPD) in asymptomatic patients; however, evidence for this recommendation has not been systematically reviewed. Methods. We examined whether screening spirometry meets standard crit eria for effective screening. We performed structured searches of MEDL INE, followed by a selective search of the CITATION index, to locate r andomized trials of interventions for asymptomatic patients with COPD. In regard to smoking cessation, we included all controlled trials of smoking cessation programs that used spirometry. We also included all studies that assessed the ability of spirometry to predict successful smoking cessation by comparing baseline lung function in smokers who s ubsequently quit versus those who did not. Results. With the exception of smoking cessation, all interventions for COPD have only been prove n effective in symptomatic patients. Two studies found that multifacet ed smoking cessation programs that included spirometry were efficaciou s. There was no effect in a third study that isolated the role of spir ometry. Smokers with abnormal spirometric results are less likely than other smokers to quit over the ensuing year. Conclusions. There is no evidence that spirometry, as an isolated intervention, aids smoking c essation. (C) 1997 Academic Press.