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Review ArticleClinical Review

Reassessment Of The Role Of Theophylline In The Current Therapy For Nocturnal Asthma

Timothy H. Self, Mark J. Rumbak, Tiffany M. Kelso and Richard A. Nicholas
The Journal of the American Board of Family Practice May 1992, 5 (3) 281-288; DOI: https://doi.org/10.3122/jabfm.5.3.281
Timothy H. Self
From the Department of Clinical Pharmacy, Division of Pulmonary Medicine of the Department of Medicine, and the UT Bowld Hospital, University of Tennessee, Memphis; and the Department of Family Medicine, University of Colorado, Denver. Address reprint requests to Timothy Self, Pharm.D., Department of Clinical Pharmacy, University of Tennessee, Memphis, TN 38163.
Pharm.D.
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Mark J. Rumbak
From the Department of Clinical Pharmacy, Division of Pulmonary Medicine of the Department of Medicine, and the UT Bowld Hospital, University of Tennessee, Memphis; and the Department of Family Medicine, University of Colorado, Denver. Address reprint requests to Timothy Self, Pharm.D., Department of Clinical Pharmacy, University of Tennessee, Memphis, TN 38163.
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Tiffany M. Kelso
From the Department of Clinical Pharmacy, Division of Pulmonary Medicine of the Department of Medicine, and the UT Bowld Hospital, University of Tennessee, Memphis; and the Department of Family Medicine, University of Colorado, Denver. Address reprint requests to Timothy Self, Pharm.D., Department of Clinical Pharmacy, University of Tennessee, Memphis, TN 38163.
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Richard A. Nicholas
From the Department of Clinical Pharmacy, Division of Pulmonary Medicine of the Department of Medicine, and the UT Bowld Hospital, University of Tennessee, Memphis; and the Department of Family Medicine, University of Colorado, Denver. Address reprint requests to Timothy Self, Pharm.D., Department of Clinical Pharmacy, University of Tennessee, Memphis, TN 38163.
M.D.
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Abstract

Background: Symptoms of asthma commonly increase at night for a variety of reasons. While different options are available for the management of nocturnal asthma, theophylline has maintained a prominent role in treating this problem, and it is widely promoted as a first-line agent. Very recent reports stress the use of anti-inflammatory agents as the drugs of choice for the long-term treatment of asthma.

Methods: Using the key words “asthma,” “theophylline,” “bronchodilators,” “adrenal cortex hormones,” “beclomethasone,” “triamcinolone acetonide,” and “disodium cromoglycate,” the MEDLINE files were searched from 1982 to the present. Articles dating before 1982 were accessed from cross-reference of the more recent articles.

Results: Sustained-release theophylline preparations are effective in decreasing the rate of exacerbations of nocturnal asthma symptoms, but theophylline has risks of major toxicity and serum concentrations must be monitored. Inhaled corticosteroids are also useful in controlling nocturnal asthma, and they reduce inflammation, which is the basic problem in asthmatics. Inhaled anticholinergics and oral controlled-release albuterol are also helpful in reducing symptoms of nocturnal asthma.

Conclusions: A suggested approach to managing nocturnal asthma includes corticosteroids inhaled through a spacer device at optimum doses, adding inhaled albuterol or oral sustained-release albuterol and then ipratropium with a spacer. If control is not maintained with this regimen, sustained-release theophylline may add benefit to inhaled steroid therapy in reducing nighttime asthma symptoms. Long-acting inhaled β2 agonists show promise and could be the adjunctive treatment of choice when they become available in the United States.

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The Journal of the American Board of Family     Practice: 5 (3)
The Journal of the American Board of Family Practice
Vol. 5, Issue 3
1 May 1992
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Reassessment Of The Role Of Theophylline In The Current Therapy For Nocturnal Asthma
Timothy H. Self, Mark J. Rumbak, Tiffany M. Kelso, Richard A. Nicholas
The Journal of the American Board of Family Practice May 1992, 5 (3) 281-288; DOI: 10.3122/jabfm.5.3.281

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Reassessment Of The Role Of Theophylline In The Current Therapy For Nocturnal Asthma
Timothy H. Self, Mark J. Rumbak, Tiffany M. Kelso, Richard A. Nicholas
The Journal of the American Board of Family Practice May 1992, 5 (3) 281-288; DOI: 10.3122/jabfm.5.3.281
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