[Longterm treatment of COPD with theophylline--still a valuable option?]

In the last decade the interest of pneumologists and therapeutic research has been focused on COPD. The increasing morbidity and mortality world wide and the important socio-economic impact challenged to improve the therapeutic options. New indications like LABA and newly introduced drugs like tiotropium may help to ameliorate symptoms, ICS potentially help to protect against exacerbations and to suppress components of the inflammatory process even in COPD. A reappraisal of the place of theophylline in the stepwise approach to treat these patients seems to be useful. This report reviews its effects as bronchodilator and the well documented additive effects in combination with betaadrenergics and anticholinergics. Further desirable actions of theophylline on the sensation of dyspnoea and on exercise capacity, on respiratory muscle function and on the cardiovascular performance are discussed but no definite conclusions can be made about the clinical utility of these effects. Given that patients are carefully selected in terms of benefit and side effects theophylline may remain a valuable therapeutic option.