YES There is a place for theophylline in asthma treatment Dr. Haluk Türktaş
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Transcript of YES There is a place for theophylline in asthma treatment Dr. Haluk Türktaş
YESThere is a place for
theophylline in asthma treatment
Dr. Haluk TürktaşGazi Üniversitesi Tıp Fakültesi
Ankara
Effective Safe Accessible Cheap Easy to use
SUITABLE DRUG
Antiinflammatory (In low doses 5-10 µg/ml)
Bronchodilator (Phosphodieterase inhibition and adenosine antagonism in high doses >15 µg/ml )
Pozitive inotrop, chronotropDiureticIncrease diaphragmatic contractilityIncrease mucociliary clearence
EFFECTS OF THEOPHYLLINE
Stephen T Holgate Allergology International. 2008;57:1-10 Bronchial Hyperreactivity
3 week interval
Theophylline induces a reduction in circulating interleukin-4 andinterleukin-5 in atopic asthmaticsE.N. Kosmas, S.A. Michaelides
Eur Respir J 1999;13:53-58
Theophylline 150 mg/day(Serum Theo 4.2 µg/ml)
Plac Theo Plac Theo
Theo 2x250 mg Wash-out Placebo
Induced sputumBALBronchial biopsy
Induced sputumBALBronchial biopsy
Low-dose Theophylline Reduces Eosinophilic Inflammation in Mild AsthmaLim S, Tomita K
Am J Respir Crit Care Med 2001:164;273-276
5 week5 week 4 week 4 week 5 week 5 week(Mean serum level 6.1 µg/ml)
Low-dose Theophylline Reduces Eosinophilic Inflammation in Mild AsthmaLim S, Tomita K
Am J Respir Crit Care Med 2001:164;273-276
A molecular mechanism of action of theophylline Kazhuiro I, PNAS 2002
Low-dose theophylline enhances the anti-inflammatory effects of steroids during exacerbations of chronic obstructive pulmonary diseaseCosio BG, Barnes PThorax in press
The place of theophylline in asthma treatment
Alternative to low dose inhaled steroids in step 2
Alternative to other controllers as add-on therapy in step 3,4,5 and 6
Aerosol beclomethasone dipropionate spray compared with theophylline as primary treatment for chronic mild-to-moderate asthmaReed CE J Allergy Clin Immunol 1998
Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthmaUkena D, Harnest U Eur Respir J 1997:10;2754-2760
Baseline Week 6BDP 800 μg·day
Baseline Week 6Theophylline/BDP
400 μg·day
Theophylline/BDP400 μg·day
BDP 800 μg·day
Baseline Week 6BDP 800 μg·day
Baseline Week 6Theophylline/BDP
400 μg·day
(Mean serum level 10.1 µg/ml)
Comparison of inhaled corticosteroid combined with theophylline and double-dose inhaled corticosteroid in moderate to severe asthmaWang Y, Lin K, Respirology 2005;10:189-195
2x250 µg BDP+ 2x500 µg BDP 2x200 mg Theo
Effects of Theophylline Withdrawal in Well-Controlled Asthmatics Treated with Inhaled Corticosteroid Kenji Baba, Ayako Sakakibara
J Asthma 2001, 38:8;615-624
Theo+BDP
Teofilin kesildikten sonra 17 hastanın 12 de atak gelişiyor
Theophylline
Effects of Theophylline Withdrawal in Well-Controlled Asthmatics Treated with Inhaled Corticosteroid Kenji Baba, Ayako Sakakibara
J Asthma 2001, 38:8;615-624
ICS Theo Theo+ICS ICS Theo Theo+ICS
Change in PEF by 28 days of treatment
Effect of theophylline plus beclometasone on lung function in smokers with asthma-a pilot study Spears MEur Respir J in press
Adding second controller to ICS
LABALTRATheophyllineCromon
Comparison of salmeterol/fluticasone propionate (FP) combination with FP+sustained release theophylline in moderate asthma patientsAdachia M, Aizawab HRespir Med 2008;102:1055-1064
Flu+Salm 250/50 µg X 2
Flu 250 µg+Theo 200mg X2
8 week
n:194
n:189
≠
NIH Asthma Guideline 2007
n:161
n: 164
n: 164
24 weeks
Clinical Trial of Low-Dose Theophylline and Montelukast in Patients with Poorly Controlled AsthmaThe American Lung Association Asthma Clinical Research CentersAm J Respir Crit Care Med 2007:175;235-242
EPACS: Episode of Poor Asthma ControlDecreased peak flow, increased β2-agonist use, increased oral corticosteroid use, or unscheduled health care visits
EPACS: Episode of Poor Asthma Control
Clinical Trial of Low-Dose Theophylline and Montelukast in Patients with Poorly Controlled AsthmaThe American Lung Association Asthma Clinical Research CentersAm J Respir Crit Care Med 2007:175;235-242
Clinical Trial of Low-Dose Theophylline and Montelukast in Patients with Poorly Controlled AsthmaThe American Lung Association Asthma Clinical Research CentersAm J Respir Crit Care Med 2007:175;235-242
Mean serum theo level
6.8 µg/ml at week 4
6.2 µg/ml at week 24
Comparison of salmeterol/fluticasone propionate (FP) combination with FP+sustained release theophylline in moderate asthma patientsAdachia M, Aizawab H Respir Med 2008;102:1055-1064
Oral candidiasis HoarsenessCoughSurrenal supressionOsteoporosisCataractGlaucom HypertensionDiabetesObesity
TachycardiaArrhytmiaTremorHypopotassemiaHyperglisemiaAnxiety
NauseAbdominal painTachycardiaArrhytmiaAnxietyConvulsion
Inhaled steroids β2-Agonist Theophylline
SIDE EFFECTS OF ANTI-ASTHMATIC DRUGS
COST OF TREATMENT(Per month)
Leukotriene antagonist 70 TL
Theophylline 4 TL
Effective Minimal side effects Accessible Cheap Easy to use
Theopylline is a suitable drug
YESThere is a place for
theophylline in asthma treatment
BRONŞ ASTIMIDr.A.Fuat KalyoncuHacettepe ÜniversitesiGögüs Hastalıkları -Eriskin Alerji Ünitesi
MethylxanthinesThey cause bronchodilatation by inhibition of phosphodiesterase and adenosine antagonism. Immunmodulation by decreasing the number of eosinophils and T-lymphocytes. Also they increase mucociliary clearence, stimulate central nervous system, increase diaphragmatic contractility and diuresis.They are the cheapest anti-asthmatic drug and they have oral, injectable and suppository preparations…..
Pregnant asthmatic patients always worry about the potential side effects of medications on the fetus. ……
Theopyllines have no side effects on the fetus except irritability and increased motion of the fetus.
Verba volant scripta manent
Dearest Fuat !