Abstract

Background: Theophylline has been widely used for decades in the treatment of asthma and chronic obstructive pulmonary disease because of its bronchodilator activity as well as its immunomodulatory, anti inflammatory, and bronchoprotective effects. On the other hand, its use has declined with the advent of potent steroid inhalants. In Austria, the current frequency of prescription is 6 in 1,000 insurants, according to Austrian health insurance data. Slow-release theophylline has become an established medication for asthma, and the development of adequate assays made drug monitoring readily available. Since the efficacy and toxicity of theophylline are closely related to the serum drug concentration, reflected by an adequate serum level of 10 - 20 mg/l, monitoring of its serum concentration is essential. Methods: This was an open-label, 1-year prospective, monocenter study, performed in male as well as female patients consecutively admitted to the Department of Environmental Dermatology, Medical University of Graz, Austria. The only inclusion criterion was taking a theophylline medication at the time of admission. Test parameters were gender, age, body mass index, nicotin abuse, medication, blood levels of the transaminases as well as serum levels of theophylline (measured by EIA). Results: 25 patients could be included (17 female, 8 male). At the time of admission, only 20% of the patients under theophylline medication had an adequate theophylline serum level, in 76% of the patients the drug was underdosed, in 4% the theophylline was found to be overdosed. After 3 days of controlled intake of theophylline preparations in 74% of the patients, an adequate theophylline level could be measured, but 36% of the patients continued to be underdosed. Conclusions: Because of the wide variation in theophylline metabolism between individuals and the narrow therapeutic index of its use, monitoring of theophylline serum levels is essential to reach an effective steady state. Despite this common knowledge, the data of our study suggest that the majority of outpatients may be below an effective level. Limitation of our study is the small number of patients included, and a larger study may be necessary to confirm the results.

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