Pharmacological Management of Chronic Obstructive Pulmonary Disease by Low-Dose Theophylline: A Prospective Hospital-based Study in East Godavari of Andhra Pradesh
B. Bhargav Prasad, Haider Shaik, M. Yasovardhan, S. Kavitha Deepthi, Pandit Vinodh Bandela, P. Subbarao
Citation Information :
Prasad BB, Shaik H, Yasovardhan M, Deepthi SK, Bandela PV, Subbarao P. Pharmacological Management of Chronic Obstructive Pulmonary Disease by Low-Dose Theophylline: A Prospective Hospital-based Study in East Godavari of Andhra Pradesh. Indian J Respir Care 2020; 9 (1):35-39.
Background: High therapeutic dose of theophylline is not tolerated well by some patients. As it is an effective and affordable drug, the effectiveness of low.dose theophylline in pharmacological management of chronic obstructive pulmonary disease (COPD) was assessed.
Aim: The aim of this study was to detect the efficacy of low.dose theophylline in COPD patients. Patients and Methods: Patients with stable COPD were enrolled. The complete blood picture (CBP), pulmonary function tests (PFTs), and St. George's Respiratory Questionnaire (SGRQ) were performed at enrolment. Patients were categorized into two groups: subjects and controls. All the participants were given medication for COPD as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. However, subjects were kept on low.dose sustained.release oral drug theophylline (150 mg twice daily) as an add.on. At every follow.up, once every 10 days up to 30 days, their parameters were recorded. The difference between the prognostic biomarkers was analyzed using the Student's “t”-test.
Results: The CBP, SGRQ, and PFTs showed improvement in COPD patients treated with low.dose theophylline, i.e., subject group. Even though the PFTs improved in subjects, evidence of COPD remained. Low.dose theophylline may help to improve the quality of life in COPD patients.
Conclusion: As a Cost-effective medication, low.dose theophylline can be used as an add.on drug to GOLD guidelines for the treatment of COPD. The subjects may feel better and can lead their normal life even with COPD.
Cosio BG, Tsaprouni L, Ito K, Jazrawi E, Adcock IM, Barnes PJ. Theophylline restores histone deacetylase activity and steroid responses in COPD macrophages. J Exp Med 2004;200:689-95.
To Y, Ito K, Kizawa Y, Failla M, Ito M, Kusama T, et al. Targeting phosphoinositide-3-kinase-delta with theophylline reverses corticosteroid insensitivity in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2010;182:897-904.
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease; 2019. Available from: https://goldcopd.org/wp-content/uploads/2019/04/GOLD_Spirometry_2019.pdf. [Last accessed on 2019 Aug 24].
Jones PW, Quirk FH, Baveystock CM. The St. George's Respiratory Questionnaire. Respir Med 1991;85 Suppl B: 25-31.
Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med 2004;350:2689-97.
Ram FS, Jones PW, Castro AA, De Brito JA, Atallah AN, Lacasse Y, et al. Oral theophylline for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002;4:CD003902.
ZuWallack RL, Mahler DA, Reilly D, Church N, Emmett A, Rickard K, et al. Salmeterol plus theophylline combination therapy in the treatment of COPD. Chest 2001;119:1661-70.
Singh D, Papi A, Corradi M, Pavliŝová I, Montagna I, Francisco C, et al. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting β2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): A double-blind, parallel group, randomised controlled trial. Lancet 2016;388:963-73.
Markham A, Faulds D. Theophylline. A review of its potential steroid sparing effects in asthma. Drugs 1998;56:1081-91.
Hirano T, Yamagata T, Gohda M, Yamagata Y, Ichikawa T, Yanagisawa S, et al. Inhibition of reactive nitrogen species production in COPD airways: Comparison of inhaled corticosteroid and oral theophylline. Thorax 2006;61:761-6.
Koo HK, Kang HK, Song P, Park HK, Lee SS, Jung H, et al. Systemic white blood cell count as a biomarker associated with severity of chronic obstructive lung disease. Tuberc Respir Dis (Seoul) 2017;80:304-10.
Kirsten DK, Wegner RE, Jörres RA, Magnussen H. Effects of theophylline withdrawal in severe chronic obstructive pulmonary disease. Chest 1993;104:1101-7.
Panahi Y, Poursaleh Z, Amini-Harandi A, Powel H, Walters EH. Study on effectiveness of low dose theophylline as add-on to inhaled corticosteroid for patients with sulfur mustard induced bronchiolitis. Asia Pac J Med Toxicol 2013;2:126-30.
Gibson PG, Coughlan J, Wilson AJ, Abramson M, Bauman A, Hensley MJ, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2000; (2):CD001117.
Devereux G, Cotton S, Barnes P, Briggs A, Burns G, Chaudhuri R, et al. Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: Study protocol for a randomised controlled trial. Trials 2015;16:267.
Waterhouse JC, Pritchard SM, Howard P. Hyperinflation, trapped gas and theophylline in chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 1993;48:126-9.
McKay SE, Howie CA, Thomson AH, Whiting B, Addis GJ. Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. Thorax 1993;48:227-32.
