O1. Inhaled bronchodilators

Inhaled bronchodilators provide symptom relief and may increase exercise capacity (Vathenen et al., 1988), (Gross et al., 1989), (Higgins et al., 1991), (Belman et al., 1996), (Jenkins et al., 1987), (Guyatt et al., 1987), (Berger and Smith 1988), (Hay et al., 1992) [evidence level I]

O1.1 Short-acting bronchodilators

O1.1.1 Short-acting beta-agonists

Regular short-acting beta-agonists improve lung function and daily breathlessness scores. A systematic review of randomised controlled trials (Ram and Sestini, 2003) found a significant increase in post-bronchodilator spirometry when compared to placebo; weighted mean difference = 140mls (95% CI 40 to 250) for FEV₁ and 300mls (95% CI 20 to 580) for FVC. There were also improvements in post-bronchodilator morning and evening PEF: weighted mean difference = 29.17 l/min (95% CI 0.25 to 58.09) for morning and 36.75 l/min (95% CI 2.57 to 70.94) for evening measurements. The relative risk of dropping out of the study was 0.49 (95% CI 0.33 to 0.73), giving a number needed to treat of 5 (95% CI 4 to 10) to prevent one treatment failure. There was no significant benefit on functional capacity, measured by walking tests, or symptoms other than breathlessness, although one randomised controlled trial has found a significant improvement in six-minute walking distance and quality of life. (Guyatt et al., 1987) Short-acting beta-agonists are now usually prescribed for use as “rescue” medication, i.e. for relief of breathlessness, rather than for regular use.