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The Guide to Clinical Preventive Services 2008 - part 4

Đối với cá nhân người trình bày để các bác sĩ lâm sàng báo cáo ho mãn tính, tăng sản xuất đờm, thở khò khè hoặc khó thở, đo phế dung sẽ được chỉ định như là một xét nghiệm chẩn đoán COPD, hen suyễn, và các bệnh phổi khác. | Screening for Chronic Obstructive Pulmonary Disease Using Spriometry Summary of Recommendation The U.S. Preventive Services Task Force USPSTF recommends against screening adults for chronic obstructive pulmonary disease COPD using spirometry. Grade D Recommendation. Clinical Considerations This recommendation applies to healthy adults who do not recognize or report respiratory symptoms to a clinician. It does not apply to individuals with a family history of a1-antitrypsin deficiency. For individuals who present to clinicians reporting chronic cough increased sputum production wheezing or dyspnea spirometry would be indicated as a diagnostic test for COPD asthma and other pulmonary diseases. Screening for COPD would theoretically benefit adults with a high probability of severe airflow obstruction who might benefit from inhaled therapies. Risk factors for COPD include current or past tobacco use exposure to occupational and environmental pollutants and older age. However even in groups with the greatest prevalence of airflow obstruction hundreds of patients would need to be screened with spirometry to defer 1 66 Screening for COPD using Spriometry exacerbation. For example under the best-case assumptions about response to therapy an estimated 455 adults between 60 and 69 years of age would need to be screened to defer 1 exacerbation. Spirometry can be performed in a primary care physician s office or in a pulmonary testing laboratory. The USPSTF did not review evidence comparing the accuracy of spirometry performed in the primary care versus referral settings. Regardless of the presence or absence of airflow obstruction all current smokers should receive smoking cessation counseling and be offered pharmacologic therapies demonstrated to increase cessation rates. All patients 50 years of age or older should be offered influenza vaccine annually. All patients 65 years of age or older should be offered pneumococcal vaccine. This USPSTF recommendation was first .