Withholding medications prior to assessing bronchodilator reversibility

Bronchodilator medication	Witholding time
SABA (eg, albuterol or salbutamol)	4 to 6 hours
SAMA (eg, ipratropium bromide)	12 hours
LABA (eg, formoterol or salmeterol)	24 hours
Ultra-LABA (eg, indacaterol, vilanterol, or olodaterol)	36 hours
LAMA (eg, tiotropium, umeclidinium, aclidinium, or glycopyrronium)	36 to 48 hours

Withholding times for post-bronchodilator testing are shorter than those for methacholine challenge testing because the bronchoprotection provided by these agents lasts longer than their bronchodilation effects. In the case of dual bronchodilators, the withholding time for the longer-acting bronchodilator is used.

SABA: short-acting beta 2-agonist; SAMA: short-acting muscarinic antagonist; LABA: long-acting beta 2-agonist; LAMA: long-acting muscarinic antagonist.

Reprinted with permission of the American Thoracic Society. Copyright © 2020 American Thoracic Society. All rights reserved. From: Graham BL, Steenbruggen I, Miller MR, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2019; 200:e70. The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society.

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Withholding medications prior to assessing bronchodilator reversibility