Theophylline Reduces Need for Steroids
March 1, 1998
Theophylline Reduces Need for Steroids
Asthma experts consider anti-inflammatory medications, especially inhaled steroids, to be fundamental to management of asthma in persons with persistent symptoms. Although low-to- moderate doses of steroid (e.g., < 1000 mcg/d budesonide or the equivalent) are often effective in achieving control, in many cases, further pharmacologic intervention is necessary. In patients for whom a moderate dose of inhaled steroids is insufficient for control, it is unclear whether the patients' interests are best served by increasing the dose of steroid or adding another class of medication.
The current study examined 62 patients with inadequately controlled asthma on 800 mcg of budesonide, comparing the addition of theophylline 250-375 mg bid with doubling the dose of inhaled budesonide. Outcome measurements included reductions in beta-2 agonist use, peak expiratory flow variability, and asthma symptom scores.
The combination of low-dose budesonide with theophylline showed superior effects on FEV1 and FVC and equally favorable effects on peak expiratory flow rates and symptom scores than the highdose budesonide over three months, even though the median theophylline concentration was below the therapeutic range (mean theophylline concentration = 8.7 mcg/mL; therapeutic = 10-20 mcg/mL).
The authors acknowledge potential anti-inflammatory and immunomodulatory attributes of theophylline. Cost analysis indicates that adding theophylline to persons with inadequately controlled asthma on moderate-dose inhaled steroids is 40% less expensive than doubling the dose of steroid.
Evans D, et al. N Engl J Med 1997; 337:1412-1418.
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