Tests are often done on patients with minimal symptoms when the physician has a high index of suspicion that the patient may have a particular disease present. In patients with a smoking history and a complaint of shortness of breath, pulmonary function studies to see if they have COPD is a usual approach, especially in our office where most of the patients come because they are short of breath. Recently, the USPSTF, U.S. Preventive Services Task Force, has recommended that no screening studies for COPD be done on patients who do not have symptoms.
This recommendation was based on studies that showed screening in asymptomatic patients did not improve mortality, morbidity or health-related quality of life. I have no basic disagreement with this recommendation. Most of the patients who come to our office are there because they are having symptoms. My concern is in primary care offices where patients may not relate all of their symptoms or feel that their shortness of breath is just due to age.
Often patients with COPD have developed their symptoms over several years and have adapted to them and consider them normal. I even have patients tell me they expect to be short of breath because they smoke, not realizing that this is a symptom of a disease which should be diagnosed and treated. I am also concerned that based on this recommendation insurance companies will deny the need for testing in some patients, unless extraordinary documentation is present. Tell your physician if you have shortness of breath.
