THE CHANGING-ROLE OF THEOPHYLLINE IN PEDIATRIC ASTHMA

The mechanism of action of theophylline in the treatment of asthma is not yet fully understood. Theophylline appears to be beneficial in som e patients with steroid-dependent or nocturnal asthma. It is recommend ed as an alternative or additional treatment for patients with chronic mild, moderate or severe disease that does not respond to first- or s econd-line therapy with beta, agonists and anti-inflammatory medicatio ns such as cromolyn sodium, nedocromil (in children 12 years of age or older) or inhaled corticosteroids. However, theophylline therapy may cause bothersome side effects, including gastrointestinal distress, an xiety, insomnia and headache. These side effects can be minimized by b eginning therapy with a low dosage and increasing the dosage slowly, u ntil a therapeutic blood level is reached. Toxicity is more likely if the blood level exceeds 20 mug per mL. Prolonged fever puts patients a t especially high risk for toxicity. Appropriate patient selection, ca reful dosing and regular monitoring are crucial elements of safe theop hylline therapy.