Chapter 51 - Theophylline

Abstract

This chapter highlights the role of theophylline in the treatment of airway diseases and discusses the future of theophylline as implicated in asthma and chronic obstructive pulmonary disease (COPD) management. Theophylline is a methylxanthine similar in structure to the common dietary xanthines, caffeine, and theobromine. Theophylline is one of the most widely prescribed drugs for the treatment of airway diseases because it is inexpensive. However, the frequency of side effects and the relatively low efficacy of theophylline have led to its reduced usage as inhaled β2-agonists are much more effective as bronchodilators and inhaled corticosteroids have a greater anti-inflammatory effect. Recent studies suggest that theophylline can have an anti-inflammatory and immunomodulatory effect, when given in low doses. At these low doses, the drug becomes easier to use, side effects are uncommon, and the problems of drug interaction are decreased, thus making the clinical use of theophylline less complicated. In the context of asthma, theophylline exhibits synergistic interaction with the anti-inflammatory mechanism of corticosteroids, and as slow-release theophylline preparations are cheaper than long-acting inhaled β2-agonists and antileukotrienes, it becomes a logical choice to use low-dose theophylline as an add-on therapy for asthma control. Selective phosphodiesterase (PDE) inhibitors are also considered for reducing the adverse effects of theophylline.