Bronchodilators in stable chronic obstructive pulmonary disease (COPD)

Inhaled bronchodilators in COPD are central to symptom management and commonly given on a regular basis to prevent or reduce symptoms (evidence A)
Regular and as-needed use of SABA or SAMA improves FEV1 and symptoms (evidence A)
Combinations of SABA and SAMA are superior compared to either medication alone in improving FEV1 and symptoms (evidence A)
LABAs and LAMAs significantly improve lung function, dyspnoea, health status, and reduce exacerbation rates (evidence A)
LAMAs have a greater effect on exacerbation reduction compared with LABAs (evidence A) and decrease hospitalisations (evidence B)
Combination treatment with a LABA and LAMA increases FEV1 and reduces symptoms compared to monotherapy (evidence A)
Combination treatment with a LABA and LAMA reduces exacerbations compared to monotherapy (evidence B) or ICS/LABA (evidence B)
Tiotropium improves the effectiveness of pulmonary rehabilitation in increasing exercise performance (evidence B)
Theophylline exerts a small bronchodilator effect in stable COPD (evidence A) that is associated with modest symptomatic benefits (evidence B)

SABA: short-acting β2-agonist; SAMA: short-acting muscarinic antagonist; FEV1: forced expiratory volume in 1 s; LABA: long-acting β2-agonist; ICS: inhaled corticosteroid.