Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it - PulmCCM
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Jun 012012
 
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Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)?

If I am reading this article right, the answer is, there’s no good reason. Consider this:

  • Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma.
  • Bronchodilator repsonsiveness can come and go on different visits by the same patient (38-52% intra-individual variability).
  • There is no consensus on the standardization of testing (which drug, dose, definition of response) or the interpretability of the results in COPD patients.
  • The absence of a BDR does not mean a patient won’t get a good benefit from bronchodilator therapy (especially long-acting). In clinical trials, those with bronchodilator repsonses did get a greater increase in lung function than those without a BDR, but those without a BDR had stat.significant improvements in dyspnea and quality of life with bronchodilator therapy compared to placebo. So you should never withhold bronchodilator therapy based on the lack of a response on testing. Guidelines argue against checking BDR for this purpose.

The main thing I took from this well-written article by Hanania et al was that checking bronchodilator response in COPD patients only has a downside: it can spur you to wrongly deny or discourage bronchodilator therapy.

So … is there any good reason to check for a bronchodilator response in someone with COPD, ever (outside of a clinical trial or research registry)?

Hanania NA et al. Bronchodilator Reversibility in COPD. CHEST 2011;140(4):1055-1063.

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  One Response to “Bronchodilator reversibility testing in COPD: Bill for it, but don’t believe it”

  1. Don´t completely agree… If response shows fully reversible obstruction, it is asthma, not COPD, and that is an important difference for treatment. If it is partially reversible it can be both asthma or COPD, and one can only make an educated guess based on age, smoking status, concomitant rhinosinusitis, allergies and so forth. If it is not reversible, it is more likely to be COPD, but could still be very chronic asthma with fixed obstruction. However, in patients with suspected COPD and partial reversibility one might be prone to treat them a little more like asthma, i.e. more on the steroid side, regardless of their GOLD classification. However, not giving bronchodilators to a patient with COPD just because he has no response to testing is against all current guidelines!

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