Management of Asthma and Chronic Airflow Limitation (Part 13)

Management of Asthma and Chronic Airflow Limitation (Part 13)Overall, the literature does not support the almost universal North American and Japanese practice of prescribing theophylline to virtually all patients with chronic airflow obstruction. Cautious and carefully monitored addition of theophylline to the therapeutic regimen should be considered only after the dose of aerosol betas adrenergic and/or anticholinergic agents has been maximized. To establish maximum improvement in airflow limitation, these patients might be given a therapeutic trial of a high-dose oral corticosteroid followed by a two-week trial of a high-dose inhaled steroid (beclomethasone 1.5 mg or the equivalent) in addition to regularly administered inhaled bronchodilators. It has been shown that 15 to 30 percent of COPD patients will demonstrate significant improvement in spirometry after such trials; however, some patients appear to respond better to the inhaled than the ingested medication or vice versa. asthma inhalers
Theophylline Toxicity
Adverse effects of theophylline and theophylline interactions with other drugs have been reviewed recently (Table 1).

Table 1 — Theophylline-Drug and Other Interactions 

With Reduced Theophylline Clearance

With Increased Theophylline Clearance

Antibiotics

Erythromycin

Phenobarbital

Quinolones

Phenytoin

Isoniazid

Albuterol (intravenous)

H2 Blockade

Isoproterenol (intravenous)

Cimetidine

Furosemide

Beta Adrenoceptor Blockade

Cigarette or marijuana smoking

Propranolol

Calcium channel blockade

Others

Allopurinol

Oral contraceptives

Caffeine

Influenza vaccine

Category: Asthma and Chronic Airflow Limitation

Tags: aminophylline, asthma, chronic airflow limitation, methylxanthine, theophylline