[The renaissance of theophylline therapy]

Deeper insight into the pharmacodynamics and pharmacokinetics of theophylline during the past 10 years led to the wide-spread use of the substance in the treatment of obstructive airway diseases. The effect of theophylline can be explained by different mechanisms of action, namely increase in cAMP and prostaglandins, redistribution of calcium, and blockade of purinergic receptors. Besides the known antiobstructive activity of theophylline ethylenediamine, its influence on the respiratory muscles is an essential clinical quality. The results of pharmacokinetic studies and routine determination of theophylline levels contributed to greatly improve the efficacy of theophylline therapy. At adequate doses, theophylline or theophylline ethylenediamine in sustained-release form constitutes the most effective long-term treatment of chronic asthma today. The pharmacological properties of ethylenediamine reinforce some of the more important effects of theophylline and improve tolerance. Combining the substance with beta-sympathomimetics elicits additive effects, while side effects are kept low.