Therapeutic responses in asthma and COPD. Bronchodilators

Chest. 2004 Aug;126(2 Suppl):125S-137S; discussion 159S-161S. doi: 10.1378/chest.126.2_suppl_1.125S.


The presence of acute reversibility to bronchodilators does not distinguish asthma from COPD. Patients with either condition can benefit from bronchodilators, and should be given a trial to assess their response. Some respond with a change in lung volume with less hyperinflation; others improve their forced inspiratory flow and become much more comfortable. The combination of long-acting beta-agonists (LABAs) and inhaled steroids is useful in both conditions. While anticholinergics seem to yield the best results in COPD, some patients with asthma benefit from their use. Tiotropium may be the most effective agent as monotherapy in COPD, but the combination of an inhaled steroid and a LABA may produce similar results in improving lung function. Long-acting bronchodilators are effective agents as monotherapy in COPD, but in asthma should be combined with a controller medication. Short-acting beta-agonists should be used intermittently in asthma, but may be used regularly or combined with an anticholinergic in COPD. The roles of stereoisomers, leukotriene receptor antagonists, and type 4 phosphodiesterase inhibitors in asthma and COPD remain uncertain at this time.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic beta-Agonists / adverse effects
  • Adrenergic beta-Agonists / therapeutic use
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Bronchodilator Agents / adverse effects
  • Bronchodilator Agents / standards
  • Bronchodilator Agents / therapeutic use*
  • Cholinergic Antagonists / adverse effects
  • Cholinergic Antagonists / therapeutic use
  • Dyspnea / drug therapy
  • Dyspnea / physiopathology
  • Forced Expiratory Volume / drug effects
  • Humans
  • Inspiratory Capacity / drug effects
  • Leukotriene Antagonists / adverse effects
  • Leukotriene Antagonists / therapeutic use
  • Phosphodiesterase Inhibitors / adverse effects
  • Phosphodiesterase Inhibitors / therapeutic use
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Stereoisomerism
  • Theophylline / adverse effects
  • Theophylline / therapeutic use


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Cholinergic Antagonists
  • Leukotriene Antagonists
  • Phosphodiesterase Inhibitors
  • Theophylline