Management of Asthma and Chronic Airflow Limitation: Conclusion
Theophylline has for decades been considered first-line therapy for acute exacerbations and for the maintenance treatment of asthma and COPD. This review presents evidence which suggests that theophylline offers little additional benefit to dose-optimized aerosol bronchodilators in the management of patients with acute exacerbations of asthma and COPD and in the maintenance therapy of asthma in adults and children. In COPD, a maintenance regimen may include theophylline if it can be demonstrated objectively, preferably by an N = 1 study, that benefit over and above that achieved by safer therapeutic modalities can be achieved.
In contrast, the betaa adrenergic, anticholinergic and steroid aerosols used in patients with asthma or COPD provide a spectrum of therapeutic choices which address not only bronchoconstriction but also, in the case of inhaled corticosteroids, the central issue of airway inflammation underlying airflow limitation. These inhaled agents are, in general, more effective, while at the same time they are virtually free of significant adverse effects, and do not require serum level monitoring, thus providing considerable cost benefit. They should be considered first-line drugs of choice in the management of patients with asthma and COPD — buy asthma inhaler, while methylxanthines should be relegated to the position of third- or fourth-line drugs. If they are used at all, they should be used selectively, cautiously and with close patient supervision and serum theophylline monitoring, and only if objective evidence of benefit over and above that of dose optimized aerosol bronchodilators and anti-inflammatory prophylactic aerosols can be demonstrated.