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Outpatient theophylline determinations.

A R Knodel, H D Covelli, J F Beekman

    The Western Journal of Medicine
    |May 1, 1984
    PubMed
    Summary
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    Serum theophylline level testing in chronic obstructive pulmonary disease (COPD) patients is most useful for those with worsening bronchospasm. Increasing theophylline dosage during testing is safe for these patients.

    Area of Science:

    • Pharmacology
    • Pulmonology
    • Clinical Chemistry

    Background:

    • Theophylline is a common medication for chronic obstructive pulmonary disease (COPD).
    • Monitoring serum theophylline levels is crucial for optimizing treatment and minimizing toxicity.
    • Outpatient theophylline level determinations are frequently performed in COPD patients.

    Purpose of the Study:

    • To prospectively evaluate the indications and clinical usefulness of outpatient serum theophylline determinations.
    • To assess the frequency of nontherapeutic theophylline values across different clinical scenarios in COPD patients.

    Main Methods:

    • 151 serum theophylline determinations were performed in 137 consecutive COPD patients.
    • Patients were categorized into three groups: worsening bronchospasm, stable asymptomatic, and suspected theophylline toxicity.

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  • Clinical data, including symptoms, timing of tests, and other bronchodilator use, were correlated with theophylline levels.

    • Main Results:

    • An increased frequency of subtherapeutic theophylline values was significantly observed in patients with worsening bronchospasm (P<.01).
    • Increasing theophylline dosage up to 15 mg/kg/day during pending determinations was found to be safe in the bronchospasm group.
    • Theophylline toxicity symptoms were infrequently associated with serum concentrations above 20 µg/mL.
    • Nontherapeutic theophylline values did not consistently lead to dosage adjustments, influenced by symptom correlation, test timing, and concurrent bronchodilator use.

    Conclusions:

    • Outpatient serum theophylline monitoring is particularly valuable in COPD patients experiencing worsening bronchospasm.
    • Current dosing guidelines for theophylline may need adjustment based on clinical presentation and monitoring results.
    • The clinical interpretation of theophylline levels should consider symptom severity, timing of sample collection, and concomitant medications.