Theophylline vs. Budesonide in the Treatment of Mild-to-Moderate Bronchial Asthma

Abstract

Eight patients with mild extrinsic asthma participated in a double-blind randomized intraindividual cross-over study involving 6 weeks’ treatment with twice daily oral theophylline (2 × 1 capsules = 800 mg/day Cronasma 400®) and 6 weeks’ treatment with twice daily inhaled budesonide (2 × 2 puffs = 0.8 mg/day Pulmicort®) with nebuhaler administered in the morning and in the evening before eating. Lung function and carbachol provocation measured with the whole-body box method were performed at the beginning and after 6 weeks of treatment. Mucociliary clearance (MC) assessed with a scintillation camera and bronchoalveolar lavage (BAL) were both performed after 6 weeks of treatment. All patients documented daily peak flows in the morning and in the evening. Additional use of β₂-agonists at night and during the day was not different for theophylline (0.10 ± 0.39 and 1.16 ± 2.87 puffs) and budesonide (0.11 ± 0.45 and 1.97 ± 3.02 puffs). MC (32 ± 15% under theophylline and 33 ± 14% after budesonide), carbachol provocation and lung function data at the end of both treatment periods were the same as well as BAL data. Two patients needed a reduction of the theophylline dose due to nausea. This study documents the equipotency of theophylline (mean blood level 11.9 ± 4.6 mg/l) and budesonide (2x2 puffs = 0.8 mg/day) in patients with mild-to-moderate asthma.

Theophylline in Asthma

“…In a randomized crossover study of eight adults with asthma who were treated with twice-daily slowrelease theophylline (mean serum concentration, 11.9 m g per milliliter) and inhaled budesonide (0.4 mg twice daily), each for six weeks, the frequency of rescue therapy with b 2 -adrenergic agonists and daily peak expiratory flow rates during the study were similar with the two treatments, as were the results of spirometry, studies of carbachol bronchoprovocation and mucociliary clearance, and cytologic analysis of bronchoalveolarlavage fluid performed at the end of each treatment period. 57 Theophylline adds substantial clinical benefit to a regimen consisting of either an inhaled corticosteroid or an oral prednisone given every other morning 11,14-16 (Fig. 1), even among patients receiving 1500 m g of beclomethasone per day.…”