Theophylline - A review of its potential steroid sparing effects in asthma

Theophylline is generally considered to be a bronchodilatory drug. However, recent pharmacodynamic studies indicate that it has anti-inflammatory effe cts.. It reduced eosinophil survival rates in vitro, and reduced eosinophil accumulation in bronchial tissue in patients with atopic asthma. Theophyll ine has also been shown to reduce T cell proliferation and accumulation. Th ese changes were mirrored by improved pulmonary function in patients with a sthma in studies that evaluated this parameter. Three randomised double-blind studies have evaluated the potential role of theophylline as an anti-inflammatory treatment in patients with asthma not controlled by low doses of inhaled corticosteroids. Patients were randomise d to receive low dose theophylline (400 to 750 mg daily) plus low dose inha led corticosteroids, or an increased dose of inhaled corticosteroids. Clini cal pulmonary function improved to the same or a greater extent in patients who received low dose inhaled corticosteroids plus theophylline than in th ose treated with high dose inhaled corticosteroids plus placebo. Where repo rted, the dosages of theophylline used in these studies resulted in serum t heophylline concentrations of approximate to 9 to 10 mg/L. Approximate mont hly costs were provided in one study: these were $60 (year and currency not specified) for theophylline plus budesonide 800 mu g/day, compared with $1 00 for budesonide 1600 mu g/day, and $155 for a regimen of budesonide 800 m u g/day and salmeterol 100 mu g/day. Conclusions: Low dose theophylline has been shown to reduce requirements fo r inhaled corticosteroid therapy in patients with asthma and may reduce ove rall treatment costs.