Which patients should be screened for COPD with spirometry?

• A. All patients with a smoking history and symptoms of COPD
• B. Asymptomatic smokers
• C. Non-smokers with chronic cough
• D. People with wheezing only during exercise

Answer: (A)

Screening for COPD with spirometry is best used when there is both risk exposure and symptoms. Patients who have a smoking history and report symptoms such as chronic cough, sputum production, or shortness of breath with activity are the ones most likely to have COPD, and spirometry serves to confirm the diagnosis by demonstrating a persistent airflow limitation (FEV1/FVC reduced after bronchodilator). Screening people who feel perfectly well, even if they smoke, hasn’t shown a clear benefit and isn’t routinely recommended. Similarly, non-smokers with chronic cough or those who only wheeze with exercise are less likely to have COPD, and other conditions like asthma or bronchitis are more likely explanations. So the group that should be screened is those with both smoking history and compatible symptoms.