EFFECTS OF THEOPHYLLINE WITHDRAWAL IN SEVERE CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

To determine the value of theophylline in the maintenance therapy of p atients with severe chronic obstructive pulmonary disease (COPD), we c onducted a trial of theophylline therapy withdrawal in 38 clinically s table patients with severe COPD (FEV1 <60 percent) predicted. Symptoms , lung function, blood gases, and 6-min walking distance were assessed on days 1 and 2. Quality of life and overall dyspnea were scored usin g four different clinical rating scales. Theophylline therapy was cont inued in 20 patients and replaced by placebo from day 3 on in the rema inder; measurements were repeated on days 5 and 6. Withdrawal of theop hylline therapy resulted in significant (p<0.05) deterioration in lung function, exercise performance, and two indices of overall dyspnea, a nd a significant increase in scoring of symptoms and auscultation find ings. Individual analysis revealed a clinically relevant deterioration in 72 percent of patients from whom theophylline therapy was withdraw n, while only 15 percent of patients receiving theophylline exhibited deterioration. No major side effects were observed. Our data show that about half of the patients with severe COPD can be considered as theo phylline responders. The response of these patients to withdrawal of t heophylline therapy suggests that the clinical effectiveness of this d rug cannot be explained exclusively by bronchodilation. Due to the inh erent difficulties in predicting response to theophylline, its effecti veness in patients with severe COPD should be determined individually, including assessment of exercise performance and ratings of dyspnea.