Theophylline

Abstract

Because it is inexpensive, theophylline remains one of the most widely prescribed drugs for the treatment of airway diseases world-wide. In many industrialized countries, however, theophylline has become a third-line treatment used only in poorly controlled patients. This has been reinforced by various guidelines to therapy. Some have even questioned whether theophylline is indicated in any patients with asthma [1], although others have emphasized the special beneficial effects of theophylline which still give it an important place in management of asthma and chronic obstructive pulmonary disease (COPD) [2•]. However, the frequency of side effects and the relative low efficacy of theophylline have led to reduced usage, because inhaled β2-agonists are far more effective as bronchodilators, and inhaled corticosteroids have a greater anti-inflammatory effect. Considerable uncertainty about the mode of action of theophylline in asthma and its logical place in therapy remain, despite its long-term use in asthma therapy. Because of problems with side effects, there have been attempts to improve on theophylline; recently, there has been increasing interest in selective phosphodiesterase (PDE) inhibitors. Selective PDE4 inhibitors, a cAMP-specific family that negatively regulates the function of almost all pro-inflammatory and immune cells and exerts widespread anti-inflammatory activity in animal models of asthma, have the possibility of improving the beneficial effects and reducing the adverse effects of theophylline, although existing inhibitors are limited by the same side effects as theophylline [3].KeywordsAsthmatic PatientSevere AsthmaAirway Smooth MuscleRespir CritAllergen ChallengeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.