Screening for COPD with spirometry

Who is screened

All patients with a smoking history and symptoms of COPD should be screened for COPD with spirometry. The symptoms named are a chronic cough with sputum production and/or chronic and progressive dyspnea.

Both parts must be there. A smoking history alone does not open the door, and that is the point the material presses.

Who is not screened

Asymptomatic individuals should not be screened with spirometry regardless of risk factors.

The case built around that rule is a 58-year-old male with a 30-pack-year smoking history who comes to discuss screening for COPD. His older brother and sister have both recently been diagnosed with COPD and he wants to be screened for this soon. He continues to smoke and does not express a desire to quit. He has no shortness of breath, no cough, no orthopnea, no paroxysmal nocturnal dyspnea and no dyspnea on exertion. His only medication is aspirin 81 mg daily, he has never used inhaled medications such as albuterol, and his family history is otherwise negative. He is counselled on tobacco cessation at that visit.

The recommended answer for him is no screening. Everything the stem piles up, the pack-years, the brother and sister with COPD, the patient's own wish to be screened, is there to draw you to the wrong answer; none of it stands against the absence of symptoms.