Bronchodilator reversibility in chronic obstructive pulmonary disease: use and limitations

Lancet Respir Med. 2013 Sep;1(7):564-73. doi: 10.1016/S2213-2600(13)70086-9. Epub 2013 Jun 18.


The change in forced expiratory volume in 1 s (FEV1) after administration of a short-acting bronchodilator has been widely used to identify patients with chronic obstructive pulmonary disease (COPD) who have a potentially different disease course and response to treatment. Despite the apparent simplicity of the test, it is difficult to interpret or rely on. Test performance is affected by the day of testing, the severity of baseline lung-function impairment, and the number of drugs given to test. Recent data suggest that the response to bronchodilators is not enhanced in patients with COPD and does not predict clinical outcomes. In this Review we will discuss the insight that studies of bronchodilator reversibility have provided into the nature of the COPD, and how the abnormal physiology seen in patients with this disorder can be interpreted.

Publication types

  • Review

MeSH terms

  • Bronchial Hyperreactivity / drug therapy
  • Bronchial Hyperreactivity / physiopathology
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / pharmacology
  • Dose-Response Relationship, Drug
  • Forced Expiratory Volume / drug effects
  • Forecasting
  • Humans
  • Predictive Value of Tests
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Time Factors
  • Treatment Outcome
  • Vital Capacity / drug effects


  • Bronchodilator Agents