Mono- and Combination Therapy of Long-acting Bronchodilators and Inhaled Corticosteroids in Advanced COPD

Jill A. Ohar; James F. Donohue

Disclosures

Semin Respir Crit Care Med. 2010;31(3):321-333. 

In This Article

Acute Bronchodilator Testing

Guidelines emphasize the comprehensive and stepwise approach to the management of COPD and stipulate that all patients who are symptomatic merit a trial of pharmacological intervention ( Table 2 ). Most guidelines require that severity of COPD be based on postbronchodilator % predicted FEV1, and choice of bronchodilator therapy is based on severity. Bronchodilator testing therefore provides appropriate categorization but does not necessarily predict response to therapy. Taskin and coworkers showed that 65.5% of subjects with moderate to very severe COPD demonstrated an acute bronchodilator response with a single evaluation.[117,118] And they have shown that a patient's FEV1 response to acute bronchodilator therapy does not predict long-term response to bronchodilator therapy and may vary from day to day. In this study, acute bronchodilator testing using albuterol, ipratropium bromide, or a combination of the two was performed on 660 COPD patients who had been classified according to both European Respiratory Society (ERS) and American Thoracic Society (ATS) spirometric criteria. Over the 2-month study period, 55% of patients classified as irreversible under ATS criteria changed to reversible status on at least one of the visits. Donohue[[119] showed that the percent of bronchodilator responders increases when evaluated with a combination of agents rather than a single agent. They reported that 73% of 813 COPD patients demonstrated a significant acute bronchodilator response (increased their FEV1 by ≥12% or 200 mL); 11% of patients showed a response to ipratropium, 27% to albuterol, and 35% to both drugs combined.. In summary, the acute response to short-acting bronchodilators varies daily, is dependent upon the type of agents used, and is of limited value in deciding future response to long-acting agents.

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