Inhaled bronchodilators are the mainstay of COPD management and include β2 agonists and anticholinergics (antimuscarinics), which are equally effective.

Examples of bronchodilators

  • Short-acting β2 agonists (SABAs) relax bronchial smooth muscle (salbutamol)1
  • Long-acting β2 agonists (LABAs) (such as salmeterol, formoterol) are preferable for patients with more significant symptoms, in GOLD Groups B to D (see Spirometric Assessment for details). Recently, 'ultra-long–acting' LABAs have been developed that require once-daily dosing (indacaterol)1
  • Anticholinergics relax bronchial smooth muscle through competitive inhibition of muscarinic receptors (M1, M2, and M3) (ipratropium).1 A long-acting quaternary anticholinergic which is M1- and M3-selective (tiotropium) may have an advantage over ipratropium, as M2-receptor blockade may limit bronchodilation

It is not clear whether pharmacologic treatment for patients with an FEV1 >80% is effective. However, GOLD recommends a short-acting bronchodilator as first choice for all Group A patients.1

The frequency of exacerbations can be reduced with the use of anticholinergics, inhaled corticosteroids, or LABAs. The initial choice among SABAs, LABAs, anticholinergics (which have a greater bronchodilating effect), and combination β2 agonist and anticholinergic therapy, is often a matter of physician and patient choice.


  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2013.

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