Bronchodilator Therapy

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The cause of expiratory airflow limitation in COPD is narrowing of the small airways caused by chronic inflammation, hypertrophy of the airway smooth muscle and enlargement of the bronchial mucus glands. The bronchoconstriction that results differs from asthma in that it is mainly located in the small airways rather than medium sized ones, it is not due to increased bronchial wall smooth muscle activity, and it is largely irreversible, although there may be a degree of reversibility to bronchodilators in a proportion of patients. The bronchoconstriction that accompanies inflammation may also produce a reversible element. This is the rationale behind the use of bronchodilator agents in the treatment of COPD, and they are used to maximize airway calibre. However, not all patients will show a measurable spirometric response to bronchodilating agents, but most will report symptomatic and functional benefit despite the lack of objective evidence of improvement.

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