Theophylline in the management of asthma: time for reappraisal?

Abstract

T Th he eo op ph hy yl ll li in ne e i in n t th he e m ma an na ag ge em me en nt t o of f a as st th hm ma a: : t ti im me e f fo or r r re ea ap pp pr ra ai is sa al l? ?P.J. Barnes*, R.A. Pauwels** Theophylline is now considered to be a bronchodilator, but it is increasingly recognized that theophylline has other anti-asthma activities, which may be more important. Theophylline, even at low plasma concentrations, inhibits the late asthmatic reaction following allergen challenge. These clinical pharmacological observations are substantiated by experimental animal and in vitro data showing that theophylline has several anti-inflammatory activities relevant to asthma. These include the inhibition of cytokine synthesis and release, the inhibition of inflammatory cell activation and microvascular leakage, and the prevention of airway hyperresponsiveness induced by airway inflammation. Theophylline appears to have immunomodulatory effects, even at relatively low plasma concentrations.Based on these considerations, theophylline can be regarded as a useful alternative to other anti-inflammatory drugs for the chronic treatment of mild to moderate asthma. Theophylline should be used at lower doses to achieve plasma concentrations of 5-10 mg·l -1 , which will avoid the risk of side-effects.Further studies are required to evaluate the role of low-dose theophylline as an adjunct to low-dose inhaled steroids in the management of chronic asthma. It may now be appropriate to re-evaluate the role of theophylline in asthma management.

Comparative evaluation of doxofylline and theophylline in patients of mild bronchial asthma

“…[14][15][16] Some more newer xanthines like acebrophylline are in market. So clinical trials to explore the interactions of doxofylline and other xanthines with corticosteroids, in asthma are thrust area of research and could lead to changes in status of xanthines in future clinical practice.…”

“…They are orally effective, have bronchodilator and anti-inflammatory action and are of proven clinical effect. 4,5,6 Methylxanthines are important class of drug used as adjuvant in step 3 and 4 of bronchial asthma treatment. In clinical practice it is also used in cases of mild bronchoconstriction, when diagnosis of asthma is not certain.…”

Controversies in the pharmacological management of acute asthma in children

“…Tanto a teofilina quanto o seu sal solúvel, a aminofilina, são capazes de promover relaxamento da musculatura lisa brônquica. Além do mais, possuem outros efeitos potencialmente benéficos para o manejo do paciente com obstrução respiratória, na função muscular diafragmática, no drive ventilatório, no clearence mucociliar, na secreção de hormônio antidiuréti-co e na inflamação 48,49 .…”

“…Pode ser prescrita com segurança desde que sejam observados cuidados relativos à dose administrada, à monitorização da sua concentração sérica, à presença de doença e/ou medicações associadas, e o aparecimento de efeitos colaterais atribuídos a sua utilização 1,30,49 .…”

Asthma in children: classification and treatment

“…Há muito utilizados no tratamento da asma, a teofilina e seus derivados têm recentemente ganho um novo impulso por conta de ação antiinflamatória 59 . A teofilina é apontada como droga terciária no manejo da asma aguda 1,4,42,60 .…”