Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

How do you reconcile this with the results of the RETHINC trial?

Answer from: at Academic Institution

Yes, I will sometimes offer a therapeutic trial of bronchodilators to symptomatic patients with radiographic emphysema, but no obstruction on spirometry. Patients with CT evidence of emphysema were not specifically studied in the RETHINC trial.

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at Geisinger Community Medical Center Pulmonary And Sleep Clinic
If they have symptoms, i.e., cough and dyspnea.

Answer from: at Community Practice

Individuals with a pre-COPD phenotype have normal spirometry, including the FEV1 and FEV1/FVC ratio, but have functional and/or structural changes concerning COPD, such as air trapping or hyperinflation, impaired diffusion capacity, or accelerated decline in FEV1 of more than 40 cc/year. Structural...

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Do you prescribe bronchodilators to patients with radiographic emphysema and respiratory symptoms, but no spirometric obstruction?

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