How is bronchodilator responsiveness assessed at the bedside?

• A. Increase in FEV1 on spirometry
• B. Observation of clinical improvement in symptoms after bronchodilator
• C. Decrease in PaCO2 after bronchodilator
• D. Improvement in DLCO after bronchodilator

Answer: (B)

Bronchodilator responsiveness at the bedside is judged by how the patient clinically improves after inhaled bronchodilator. In the bedside setting you don’t have immediate access to formal lung function tests, so you look for tangible relief: reduced breathlessness, easier talking, decreased work of breathing and use of fewer accessory muscles, quieter or clearer breath sounds, and, if available, better oxygen saturation or respiratory rate. While a rise in FEV1 on spirometry is a standard objective measure of bronchodilator response, it requires specialized testing and isn’t something you can do at the bedside. Changes in PaCO2 or DLCO aren’t reliable or practical bedside markers for acute bronchodilator responsiveness. So the best bedside indicator is the patient’s clinical improvement in symptoms after the bronchodilator.