Revisiting an old therapy: Theophylline in asthma

The use of theophylline for the treatment of asthma has decreased significantly over the past few decades. Nonetheless, clinicians may still encounter patients with theophylline-based asthma regimens. While theophylline's exact mechanism of action is not defined, new theories infer that the benefit of theophylline is due to its antiinflammatory, rather than bronchodilatory, effects. Clinical trials have explored the combination of theophylline with lower doses of corticosteroids as a steroid-sparing strategy. Complex pharmacokinetics, significant adverse effects, and interpatient variability have contributed to the decreased use of this medication for asthma. Clinicians should be cognizant of the appropriate initial dosing, variety of formulations, and timing of theophylline levels to reduce toxicity and better control asthma symptoms. This review summarizes literature supporting the use of low-dose theophylline as an adjunct to orticosteroids in asthma, as well as pharmacokinetics, drug interactions, and adverse effects associated with its traditional dosing strategy.