Bronchodilator reversibility in COPD.
Hanania NA, Celli BR, Donohue JF, Martin UJ
Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research
Center (Dr Hanania), Baylor College of Medicine, Houston, TX; Division of
Pulmonary and Critical Care Medicine (Dr Celli), Brigham and Women¹s
Hospital, Harvard University, Boston, MA; Division of Pulmonary Disease
and Critical Care Medicine (Dr Donohue), University of North Carolina at
Chapel Hill, Chapel Hill, NC; and Clinical Research, Respiratory and
Inflammation Therapeutic Area (Dr Martin), AstraZeneca LP, Wilmington, DE.
Abstract
COPD is a preventable and treatable disease characterized by airflow
limitation that is not fully reversible. The diagnosis of COPD is based on
spirometric evidence of airways obstruction following bronchodilator
administration. Although it used to be commonly believed that patients
with COPD have largely irreversible airflow obstruction, evidence now
suggests that a considerable proportion of patients exhibit clinically
significant bronchodilator reversibility. The complexity and inherent
variability of a patient’s acute response to a bronchodilator and the lack
of a standardized procedure for assessing bronchodilator reversibility
have led to significant confusion surrounding this concept. Although
bronchodilator reversibility commonly is defined based on thresholds for
improvement in FEV(1), lung volume-based measures of pulmonary function
may be of particular importance in patients with severe COPD. The
usefulness of acute reversibility to short-acting bronchodilators in
predicting a patient’s long-term response to bronchodilator maintenance
therapy is also unclear, although most studies suggest that a lack of
acute response to short-acting bronchodilators does not preclude a
beneficial long-term response to maintenance bronchodilator treatment.
This review outlines recent findings about the prevalence and usefulness
of bronchodilator reversibility in patients with COPD based on the
available literature and proposes areas of future research.
PMID: 21972384
