A comparison between inhaled salmeterol and theophylline in the short-term treatment of stable chronic obstructive pulmonary disease

Broseghini, C; Testi, Rossana; Polese, Guido; Tosatto, R.; Rossi, Andrea

doi:10.1016/j.pupt.2004.10.006

Cited by 12 publications

(24 citation statements)

References 19 publications

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“…[260261262263] When added to a combination of formoterol and tiotropium, theophylline failed to show any added advantage. [264] Hence, current evidence does not support the use of theophylline as a primary agent for pharmacotherapy of stable COPD.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

et al. 2013

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Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

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Section: Introductionmentioning

confidence: 99%

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

et al. 2013

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“…Formoterol and salmeterol have demonstrated similar or greater improvements in lung function compared with ipratropium bromide [26,29,39,44,45] and significantly greater improvements compared with theophylline [35,46,59], but appear to be less effective than tiotropium [21,60]. …”

Section: Introductionmentioning

confidence: 99%

Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents

2010

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Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation and debilitating symptoms. For patients with moderate-to-severe COPD, long-acting bronchodilators are the mainstay of therapy; as symptoms progress, guidelines recommend combining bronchodilators from different classes to improve efficacy. Inhaled long-acting β2-agonists (LABAs) have been licensed for the treatment of COPD since the late 1990s and include formoterol and salmeterol. They improve lung function, symptoms of breathlessness and exercise limitation, health-related quality of life, and may reduce the rate of exacerbations, although not all patients achieve clinically meaningful improvements in symptoms or health related quality of life. In addition, LABAs have an acceptable safety profile, and are not associated with an increased risk of respiratory mortality, although adverse effects such as palpitations and tremor may limit the dose that can be tolerated.Formoterol and salmeterol have 12-hour durations of action; however, sustained bronchodilation is desirable in COPD. A LABA with a 24-hour duration of action could provide improvements in efficacy, compared with twice-daily LABAs, and the once-daily dosing regimen could help improve compliance. It is also desirable that a new LABA should demonstrate fast onset of action, and a safety profile at least comparable to existing LABAs.A number of novel LABAs with once-daily profiles are in development which may be judged against these criteria. Indacaterol, a LABA with a 24-hour duration of bronchodilation and fast onset of action, is the most advanced of these. Preliminary results from large clinical trials suggest indacaterol improves lung function compared with placebo and other long-acting bronchodilators. Other LABAs with a 24-hour duration of bronchodilation include carmoterol, vilanterol trifenatate and oldaterol, with early results indicating potential for once-daily dosing in humans.The introduction of once-daily LABAs also provides the opportunity to develop combination inhalers of two or more classes of once-daily long-acting bronchodilators, which may be advantageous for COPD patients through simplification of treatment regimens as well as improvements in efficacy. Once-daily LABAs used both alone and in combination with long-acting muscarinic antagonists represent a promising advance in the treatment of COPD, and are likely to further improve outcomes for patients.

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“…This might explain why theophyllines added to ICS were more effective then LABA added to ICS in reducing the rate of exacerbations. However, RCTs have shown that patients treated with LABA [33, 34] or LABA plus ICS [35] have a significant greater improvement in lung function [forced expiratory volume in 1 s (FEV 1 ), forced vital capacity and morning peak expiratory flow], a higher percentage of symptom‐free (cough, wheezing and shortness of breath) days and use less rescue medications (salbutamol or albuterol) than patients treated with theophyllines [33, 34, 36] or theophyllines plus ICS [35].…”

Section: Discussionmentioning

confidence: 99%

Effect of theophylline on the rate of moderate to severe exacerbations among patients with chronic obstructive pulmonary disease

Beauchesne

Lemière

Blais

2007

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Despite active research, none of the existing medications used to treat chronic obstructive pulmonary disease (COPD) has been shown to modify the long‐term decline in lung function. • Theophyllines have been recognized for their bronchodilating effects and anti‐inflammatory properties, but at the same time they are associated with the risk of adverse events due to their narrow therapeutic range and potential for drug interactions. • To our knowledge, no study has investigated the effects of theophylline on outcomes that can reflect the overall morbidity of COPD patients. WHAT THIS STUDY ADDS • The use of theophyllines is associated with a reduction in the rate of COPD exacerbations compared with long‐acting β2‐agonists among COPD patients. • Theophyllines could be seen as an interesting alternative in the treatment of COPD, because they are much less expensive than long‐acting β2‐agonists, and, from the patient's perspective, an oral formulation might be easier to take than an inhaled formulation. AIM To determine the effectiveness of theophyllines in real clinical practice on moderate to severe exacerbations. METHODS A cohort of 36 492 chronic obstructive pulmonary disease (COPD) patients aged ≥50 years was reconstructed from the health administrative databases of the province of Quebec, Canada, between 1 January 1995 and 31 December 2002 to compare users of theophyllines with users of inhaled corticosteroids (ICS) and users of long‐acting β2‐agonists (LABA) on their rate of moderate to severe COPD exacerbations. RESULTS Users of theophyllines were found to be less likely than users of LABA [crude rates 84 vs. 91 per 100 patient‐years, adjusted rate ratio (RR) 0.89, 95% confidence interval (CI) 0.84, 0.95] and users of theophyllines plus ICS were found to be less likely than users of LABA plus ICS (crude rates 114 vs. 112 per 100 patient‐years, adjusted RR 0.89, 95% CI 0.87, 0.92) to have moderate to severe COPD exacerbations. Users of theophyllines were found to be more likely than users of ICS to have a COPD exacerbation (crude rates 84 vs. 77 per 100 patient‐years, adjusted RR 1.07, 95% CI 1.04, 1.10), and this association was even stronger among patients who had at least three exacerbations in the year prior to cohort entry (crude rates 273 vs. 213 per 100 patient‐years, adjusted RR 1.28, 95% CI 1.19, 1.38). CONCLUSION The use of theophyllines was found to be associated with a reduction in the rate of COPD exacerbations among all COPD patients, but to be less effective than ICS among patients with frequent exacerbations.

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A comparison between inhaled salmeterol and theophylline in the short-term treatment of stable chronic obstructive pulmonary disease

Cited by 12 publications

References 19 publications

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

Long-acting beta-agonists in the management of chronic obstructive pulmonary disease: current and future agents

Effect of theophylline on the rate of moderate to severe exacerbations among patients with chronic obstructive pulmonary disease

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