Theophylline again? Reasons for believing

Abstract

So, what is new for theophylline in asthma? Theophylline has been used over the last 70 years for treating patients with asthma. It is well known as a bronchodilator and the current asthma guidelines recommend it as an add-on therapy in noncontrolled asthmatics 1. More than a decade ago, Evans et al. 2 showed that adding theophylline is equally effective as doubling inhaled corticosteroid (ICS) doses for asthma control. In a recent issue of the European Respiratory Journal , Spears et al. 3 reported significant improvements in both lung function and asthma control score in smoking asthmatics who are treated with a combination of low-dose theophylline and beclomethasone compared with each drug alone. The potential relevance of this small, self-labelled pilot trial is that to our knowledge, it is the first to test an effect of this mechanism in smokers. Worldwide, one in every four asthmatics still smokes; interestingly, the prevalence of smoking in asthmatics mirrors the population prevalence of smoking in that geographic population 4. Every smoker should quit but anyone with asthma or any other respiratory condition should be offered all options and help to achieve full smoking cessation. So, what is the point? Something has changed in our scientific knowledge of the mechanism of action of theophylline in recent years. Since Ito et al. 5 described in vitro a novel …