Management of Asthma and Chronic Airflow Limitation (Part 12)
In recent years there has been increasing evidence that inhaled anticholinergic receptor antagonists such as atropine, ipratropium bromide, oxytropium bromide and atropine methonitrate may provide greater and more prolonged bronchodilatation in patients with COPD than adrenoceptor agonists. No studies have yet examined the additional clinical and physiologic benefit of theophylline when added to dose-optimized inhaled anticholinergic agents with or without adrenoceptor agonists.
In summary, the precise role of theophylline in stable chronic airflow limitation remains controversial. Addition of this agent to a regimen employing larger doses of aerosol beta adrenergic agonists is expected to produce modest but statistically significant additional bronchodilatation of questionable clinical relevance in only 40 to 50 percent of patients. The cost-benefit of adding theophylline to optimized doses of aerosolized adrenoceptor agonist and anticholinergics has not been established, and to do so would require administration of the inhaled medications to achieve an individualized response plateau, and a quality of life assessment that would take into account not only the reduction in breathlessness and increased effort tolerance but also the side effects of these . To date, no study has yet convincingly established that theophylline use in patients given optimum doses of aerosol bronchodilators enhances quality of life, exercise or functional capacity.