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Need for theophylline in severe steroid-requiring asthmatics
M Brenner1, R Berkowitz, N Marshall
1Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Clinical Allergy
|March 1, 1988
Summary
Theophylline is crucial for severe asthma patients unresponsive to other treatments. Removing it led to steroid increases and exacerbations, proving its benefit in this subset.
Area of Science:
- Pulmonology
- Clinical Pharmacology
Background:
- Severe asthma management often involves multiple medications.
- Theophylline's role is debated due to side-effect concerns.
- Reducing systemic steroid use is a key treatment goal.
Purpose of the Study:
- To determine if theophylline can be removed from the regimen of severe asthmatics.
- To assess the impact of theophylline withdrawal on clinical stability and steroid requirements.
Main Methods:
- A double-blind, cross-over trial comparing theophylline and placebo in five severe asthmatic inpatients (12-15 years old).
- Patients were on maximal therapy including systemic steroids and inhaled medications.
- Outcome measures included symptom scores, need for rescue treatments, steroid dosage, and spirometry.
Main Results:
- All patients required increased steroid dosage during the placebo period.
- Spirometry significantly decreased when theophylline was withdrawn.
- Three patients experienced severe exacerbations without viral triggers upon theophylline discontinuation.
Conclusions:
- Theophylline is beneficial for a specific group of severe asthmatics.
- These patients remain uncontrolled despite comprehensive treatment with other medications.
- Theophylline plays a vital role in maintaining clinical stability for this subset.