Hyperreactivity and bronchial obstruction

The main obstructive components in bronchial asthma and chronic obstructive pulmonary disease (COPD) are discussed. It is underscored that bronchospasm plays a significant role also in COPD, and that it merits specific treatment (beta 2-stimulants, antimuscarinics, theophylline) even when, in some cases, obstruction appears to be 'irreversible'. The majority of COPD patients react positively, although to a lower degree than asthmatics, not only to chemical agents (histamine, methacholine), but also to 'osmotic' stimuli, such as ultrasonically nebulized distilled water. Geometric factors seem to be in part responsible for the anomalous response. Considering the potent antireactive activity of bronchodilators (beta 2-stimulants in particular), this finding is a further indication for a regular bronchodilator treatment in COPD. Whether such a therapy serves also to improve the prognosis of COPD in the long run has not yet been established.