Bronchodilator responsiveness testing: methodology, clinical application and controversial questions

   The bronchodilator test (BDT) is a component of spirometry widely used to assess the degree of improvement of lung function in response to bronchodilator administration.

   The aim of the study was to evaluate and systematize modern approaches to performing BDT to determine the reversibility of obstructive disorders, as well as to critically analyze the criteria for interpreting its results and its clinical significance in the diagnosis of obstructive pulmonary diseases.

   An analytical review of international and national clinical guidelines, as well as scientific publications on spirometry, bronchodilator testing, and the diagnosis of chronic obstructive pulmonary disease (COPD) / bronchial asthma (BA) for the period 1974–2025 was conducted. Indications, contraindications, and the methodology for performing BDT were systematized. Various criteria for a positive bronchodilator response were analyzed: from the classic criterion (+12 % and ≥ 200 mL from baseline of Forced Expiratory Volume in 1 second (FEV1) and Forced Vital Capacity (FVC)) to modern approaches using predicted values (+10 % of predicted) and z-scores. It was established that the detection rate of obstructive disorders using post-bronchodilator spirometry values is 11–35% lower compared to pre-bronchodilator data. It has been shown that BDT is not a reliable tool for differentiating between bronchial asthma and COPD; however, a positive response can be considered a modifiable trait. For the diagnosis of COPD, it is advisable to use post-bronchodilator spirometry values. To date, there is no single universal standard for performing the bronchodilator test. The choice of a specific drug, its dose, the method of inhalation, and the criteria for a positive response should be dictated by the specific clinical task. The current variability in methodology indicates the need for further research to standardize BDT.

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