Chronic obstructive pulmonary disease (COPD) is usually treated as a single disease of smokers, and guidelines recommend the same bronchodilator treatment whether or not a patient has ever smoked. A new study published in BMC Pulmonary Medicine challenges that assumption by comparing how ever-smokers and never-smokers with COPD respond to two inhaled bronchodilators: salbutamol, a short-acting agent, and glycopyrronium, a long-acting muscarinic antagonist. The researchers report that both groups benefited from both drugs, but never-smokers showed consistently greater and more frequent improvements in lung function.
The team recruited COPD patients from an outpatient department and performed pragmatic on-the-spot spirometry, measuring airflow before treatment, after salbutamol, and then after glycopyrronium. The ever-smoker group comprised 461 patients, who tended to be older and predominantly male, while the never-smoker group comprised 418 patients. Across all three measurement states, never-smokers had statistically better FEV1 percent predicted, FEV1/FVC ratio, and FEF25-75 percent predicted values than ever-smokers.
The improvement in these parameters followed a similar trend in both groups, but the gains were significantly larger for FEV1 and FEF25-75 in never-smokers at every stage of measurement. Responsiveness, defined as a change in FEV1 of at least 100 ml, was also more frequent among never-smokers for glycopyrronium alone and for the combined salbutamol-plus-glycopyrronium assessment, at both the 100 ml and the more lenient 50 ml thresholds. In contrast, patients whose FEV1 changed by less than 50 ml on combined testing had worse lung function, a difference that was mostly significant among ever-smokers compared with those showing more than 50 ml of combined responsiveness.
The authors conclude that COPD responds to both salbutamol and glycopyrronium irrespective of smoking history, but that never-smoker COPD displays a higher frequency of responsiveness and better improvement in FEV1 and FEF25-75. They emphasize that more research is needed to understand the cause of this difference. The findings are observational and derived from a single outpatient cohort, so they do not by themselves justify changing prescribing practice; rather, they suggest that smoking history may mark clinically relevant differences in airway biology and bronchodilator responsiveness that current one-size-fits-all guidelines do not account for.
Subject of Research: Bronchodilator responsiveness to salbutamol and glycopyrronium in ever-smoker versus never-smoker COPD
Article Title: Ever-smoker and never-smoker COPD from the prism of salbutamol and glycopyrronium responsiveness: an appraisal
Article References: Bhattacharyya, P., Dey, D., Sen, S., Ghosh, S., & Banerjee, R. (2026). Ever-smoker and never-smoker COPD from the prism of salbutamol and glycopyrronium responsiveness: an appraisal. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04889-6
Image Credits: AI Generated
DOI: 10.1186/s12890-026-04889-6
Keywords: COPD, bronchodilator responsiveness, salbutamol, glycopyrronium, spirometry, never-smokers, ever-smokers, FEV1, FEF25-75, lung function, BMC Pulmonary Medicine, smoking history
