Chronic Obstructive Pulmonary Disease and Bronchodilator Response: Does it Matter?

A positive bronchodilator response is found in most patients with moderate-to-very-severe chronic obstructive pulmonary disease (COPD), although its presence varies over time within the same patient as well as across patients depending, in part, on the severity of the pre-bronchodilator level of airflow obstruction. Consequently, the response to a bronchodilator does not reliably distinguish COPD from asthma, although a particularly marked response suggests the presence of asthma/COPD overlap. The absence of an acute response to a bronchodilator in COPD does not preclude a favourable long-term response to maintenance bronchodilator therapy, although it may predict a reduced magnitude of the long-term response. Bronchodilator responsiveness does not appear to define a distinct phenotype of COPD or predict most clinically meaningful outcomes. However, performing spirometry after a bronchodilator may have practical utility in clinical practice as an indicator of the maximum (“ceiling”) lung function that patients are capable of attaining as a goal to attempt to achieve with pharmacotherapy.