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Theophylline: is it obsolete for asthma?
1Division of Allergy and Clinical Immunology, Crozer-Chester Medical Center, Chester, Pennsylvania 19013.
Insights
Theophylline remains a primary treatment for moderate childhood asthma, balancing efficacy against potential side effects. Patient selection is key to maximizing benefits and ensuring adherence for effective asthma control.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
Background:
- Theophylline is a widely used medication for managing moderate asthma in children.
- Despite potential gastrointestinal and central nervous system side effects, it remains a cornerstone therapy.
Purpose of the Study:
- To review the role of theophylline in pediatric asthma management.
- To discuss patient selection, pharmacodynamics, metabolism, and clinical application of theophylline.
Main Methods:
- Literature review of theophylline's use in pediatric asthma.
- Discussion of pharmacologic properties, clinical guidelines, and patient management.
Main Results:
- Theophylline's effectiveness is influenced by asthma severity, triggers, cost, side effects, and patient/parental preferences.
- It is primarily used for daily prophylaxis against allergic and nonallergic asthma triggers.
Conclusions:
- Careful patient selection is crucial for optimizing theophylline therapy in children with moderate asthma.
- Comprehensive management includes dosage titration, monitoring, ensuring compliance, and appropriate weaning strategies.
Abstract:
Theophylline, despite its potential for causing gastrointestinal tract and central nervous system side effects, is still the major drug used to control symptoms of moderate asthma in children. Selection of patients who will benefit most from this treatment is based on asthma frequency, severity, and triggers; the cost and side effects of theophylline; the likelihood of compliance; and the wishes of both patient and parent. Theophylline's pharmacodynamics, metabolism, and proposed mechanisms of action are discussed, as are the use of specific preparations and possible side effects. Although theophylline can be used in the acute care setting, its major use is in daily continuous prophylaxis against events triggered by either allergic or nonallergic factors. In addition to dosage and titration, aspects of monitoring, compliance, and weaning are discussed.