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Bronchodilator Reversibility in COPDBronchodilator Reversibility in COPD

Nicola A. Hanania, MD, FCCP; Bartolome R. Celli, MD, FCCP; James F. Donohue, MD, FCCP; Ubaldo J. Martin, MD, FCCP
Author and Funding Information

From the 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 Women’s 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.

Correspondence to: Nicola A. Hanania, MD, FCCP, Baylor College of Medicine, 1504 Taub Loop, Houston, TX 77030; e-mail: hanania@bcm.tmc.edu


Funding/Support: This work was funded by AstraZeneca LP.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1055-1063. doi:10.1378/chest.10-2974
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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 FEV1, 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.

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