Bronchodilator responsiveness in patients with COPD.

Eur Respir J. 2008 Feb 6 [Epub ahead of print]Click here to read Links Tashkin DP, Celli B, Decramer M, Liu D, Burkhart D, Cassino C, Kesten S. UCLA, Los Angeles, CA, United States.

The degree of acute improvement in spirometric indices after bronchodilator inhalation varies among COPD patients and depends on the type, dose and timing of bronchodilator administered.

We examined acute bronchodilator responsiveness at baseline in a large cohort of patients with moderate to very severe COPD participating in UPLIFT, a 4-year, randomized, double-blind trial evaluating the efficacy of tiotropium 18 mcg daily in reducing the rate of decline in lung function. After washout of respiratory medications, patients received 80 mcg ipratropium followed by 400 mcg albuterol. Spirometry was performed before and 90 minutes following ipratropium. Criteria used for FEV1 responsiveness: >/=12% and 200 ml, >/=15% increase over baseline, and >/=10% absolute increase in percent predicted.

5,756 patients had data meeting criteria for analysis. Age=64.5 years; males=75%. Baseline FEV1=1.10 L (39.3% predicted) and FVC=2.63 L. Compared with baseline, mean improvements in FEV1=229 ml, FVC=407 ml. 53.9% of patients had 12% and 200 ml improvements in FEV1; 65.6% had >/=15% improvement in FEV1; and 38.6% had >/=10% absolute increase in FEV1 percent predicted.

The majority of patients with moderate to very severe COPD demonstrate meaningful increases in lung function following administration of an inhaled anticholinergic plus sympathomimetic bronchodilators.




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