O1.3 Assessment of response and continuation of bronchodilator therapy

In some patients a response to bronchodilator therapy may require treatment for up to two months. Symptomatic and functional benefits can often be demon­strated in the absence of an increase in FEV1. Other objective measurements, such as an increase in exercise capacity (e.g. as measured using a walking test such as the six minute walk test or the incremental or endurance shuttle walking test (Pepin 2007, Pepin 2005) or an increased inspiratory reserve capacity, may be useful indicators of physiological improvement.

Subjective measurements, such as quality of life, breath­lessness and functional limitation (e.g. MRC Dyspnoea Scale), can determine the patient’s perception of benefit.

If there is no improvement:

  • check inhaler technique;
  • consider psychosocial issues and deconditioning; and
  • exclude other causes of exercise impairment (consider specialist referral or a cardiopulmonary exercise test).