Background and objectives: The burden of chronic obstructive pulmonary disease (COPD) disproportionately affects patients in low to middle-income countries. Theophylline as add-on therapy was no use in preventing COPD exacerbations. Theophylline is derived from methylxanthine, naturally present in tea and cocoa beans. Doxofylline, another xanthine, is an effective bronchodilator and displays a better safety profile than theophylline. 低劑量Theophylline不能減少COPD急性惡化(Low-Dose Theophylline Can Not Reduce Exacerbation In Patients With COPD) 下午3:08:00 Theophylline 應該算是最老牌的支氣管擴張劑之一，藥理學老師都說它具有神奇的功效，不但可以增加橫膈膜收縮力、擴張支氣管、還附有利尿，甚至減少腎臟 . If this is correct this should improve symptoms, reduce exacerbations, and reduce the progression of the disease. Includes how well they work and side effects. The patient is experiencing a COPD exacerbation. Instead, the hospitalization rate and mortality increased with theophylline. Exacerbations will be treated with antibiotics and/or oral corticosteroids by study clinicians per standard protocol in . Lists generic and brand names such as theophylline (Theo-24). However, there are few studies addressing the compliance of these patients with their drug regimen or of the efficacy of usual oral doses of theophylline in achieving therapeutic levels. 5 Theophylline was prescribed to 35% of patients with COPD in the past and up to 64% in Taiwan because theophylline is convenient to use and inexpensive. Chronic Obstructive Pulmonary Disease (COPD) is a serious pulmonary condition. comments. typically used in combination for patients with a COPD exacerbation. Low-cost oral medications, if effective, could enable affordable, accessible COPD treatment. Although the Theophylline and Steroids in COPD Study (TASCS) showed no clinical benefit from administering low-dose theophylline and prednisone in COPD patients compared to placebo, it was hypothesized that those with elevated blood . The findings do not support the use of low-dose theophylline as adjunctive therapy to inhaled corticosteroids for the prevention of COPD exacerbations. Smoking; In UK, 90% of COPD is caused by long-term smoking A recent study found that theophylline enhancedthe effectiveness of salmeterol in the management of COPD. Salmeterol and theophylline are indicated for the treatment of COPD, but the use of these agents in combination has not been extensively studied. It provides relief over six to 24 hours. Documentation of previous spirometry, smoking history and functional capacity is important in assessment of patients with AECOPD. 2001; 119:1840-9 CONCLUSION: Based on current evidence, low-dose theophylline as add-on therapy to ICS did not reduce the exacerbation rate. Objectives: To compare the efficacy and safety of salmeterol plus theophylline vs either agent alone in COPD. How does theophylline for COPD work? Leuppi (2013) JAMA 309(21):2223-31 [PubMed] Key Points. O2. Many patients experience exacerbations and some require Emergency Room visits and hospitalization. The guidelines of the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease (GOLD) currently recommend consideration of the addition of an oral or intravenous methylxanthine to aerosolised bronchodilators for severe exacerbations of chronic obstructive pulmonary disease (COPD). Medical. Theophylline and Steroids in Chronic Obstructive Pulmonary Disease (COPD) Study (TASCS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A large-scale prospective study of theophylline use investigating both safety and efficacy is warranted. It is typically taken by mouth for the long-term control and maintenance of asthma, COPD (including emphysema and chronic bronchitis ), and other chronic lung diseases. Adults with chronic obstructive pulmonary disease (COPD) who are at high risk for exacerbation and who are treated with both inhaled corticosteroids and low-dose theophylline as adjunct therapy had no fewer exacerbations than those not treated with theophylline, according to the results of a study published in the Journal of the American Medical Association. Reproduced from [1] with permission from the publisher. 2003; 163:1180-1186. In a U.K. study, 1567 patients with moderate-to-severe COPD and recurrent exacerbations were randomized to low-dose theophylline (200-400 mg . used to improve oxygen saturation to 88-92% or a PaO2 of approximately 60 to 70 mmHg. See Stepped Management as above; See Antibiotic Use in COPD Exacerbation; Do not define exacerbation severity by Spirometry; Consider Chest XRay in hospitalized patients; Prednisone 40 mg orally daily (5 day course is typical). In total, there were 3430 exacerbations: 1727 in the theophylline . O2 supplementation. the only treatment to improve mortality in patients with COPD. The average theophylline level was 10.8 micrograms/mL. Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. [1] Most episodes of AECOPD result from infections, with bacterial etiologies being the most common. Recurrent exacerbations are unusual in patients with mild COPD. An alternative route of administration to treat chronic cough. Chest. An exacerbations of COPD is a rapid and sustained worsening of symptoms beyond normal day-to-day variations Epidemiology of COPD. The mean number of exacerbations in participants allocated to theophylline and placebo groups were essentially the same: 2.24 vs. 2.23. Methods: This is a part of an ongoing double-centre prospective controlled study conducted over period of 1 year. 1, 2 Current treatments for COPD are aimed at increasing airflow, decreasing respiratory symptoms (particularly dyspnea), decreasing exacerbations, and improving the quality of life. D Low-dose theophylline may be considered in patients with COPD where Oral bronchodilators O2.1 Methylxanthines Theophylline is rarely used for COPD in Australia. Nevins ML, Epstein SK. TWICS is a double-blind randomised, placebo-controlled, UK multicentre clinical trial comparing the addition of 'low dose' theophylline or placebo for 52 weeks with current COPD therapy that includes inhaled corticosteroids in COPD patients who in the previous year have had two or more exacerbations of COPD treated with oral corticosteroids or antibiotics. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality world-wide. The adverse effects of theophylline include: Gastrointestinal disorders such as nausea, vomiting, gastro-oesophageal reflux. Neurological disorders such as tremor, headache, dizziness, central nervous system stimulation, insomnia, and convulsion (rare). respiratory No role for add-on theophylline to prevent COPD exacerbations Low-dose theophylline does not significantly reduce the number of exacerbations in patients with COPD when added to inhaled corticosteroids, new. In the paper by Cosio and colleagues on the effect of low-dose theophylline on the anti-inflammatory effects of steroids during exacerbations of chronic obstructive pulmonary disease (COPD), the . oral administration of slow-release theophylline in COPD patients. Patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) frequently present with a history of previous outpatient theophylline use. 3. We determined the following at baseline and at the end of 52 weeks of follow-up: (1) HDAC activity in blood monocytes and sputum . Seventy-nine patients with a mean age of 64.3 years were entered into the study. Background: Theophylline, being cheap, continues to be used widely in developing countries for treating COPD. Other types of bronchodilators may be short-acting. 180.17 g/mol.. COPD patients and reverts steroid insensitivity in vitro and ex vivo [12]. COPD, additional medications may be used, such as theophylline and roflumilast. 9 In a randomized trial of 30 patients with COPD treated with oral theophylline to maintain a serum concentration of 8.8 to 12.4 mg/L or . While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most . 7 The combinationtherapy provided significantly greater improvement in pulmonary functionthan either agent alone and was associated with a greater decrease in respiratorysymptoms (including dyspnea), albuterol use, and COPD exacerbations . Methylxanthines (theophylline), antibiotics, antiviral agents, and oxygen therapy Conditions other than COPD Frequent infections and/or possible bronchiectasis, frequent exacerbations, acute COPD exacerbations, or post hospital discharge for COPD exacerbations Assessment for hypoxemia and hypercapnia . Reliever therapy for acute exacerbations. Introduction. Chronic bacterial colonization of the airways contrib-ute to the inflammatory response of COPD [13] and to disease progression [14-16]. It can also be given intravenously (into a vein) for treatment for severe asthma attacks or COPD exacerbations . Low-Dose Theophylline Not Effective at Reducing COPD Exacerbations, Study Finds Oral theophylline has been used as a bronchodilator to treat chronic obstructive pulmonary disease (COPD) for. Theophylline as add-on therapy was no use in preventing COPD exacerbations. if patients are using theophylline, warfarin, carbamezepine, digoxin; ƒ: consider if patient has recently been on antibiotics. We will utilize ATS/ERS guidelines regarding exacerbation definition and severity. Patil SP, Kirshnan JA, et al. Inhaled corticosteroid (ICS) Minimizes risk of COPD exacerbation, modest increase in pneumonia risk Used on a set schedule. ipratropium and albuterol. In this prospective, double-blind, placebo-controlled clinical trial, we randomized patients with COPD (FEV 1 < 50% predicted plus at least one hospitalization due to exacerbation in the previous year) to ICS plus theophylline 100 mg bid or matched placebo. Discussion Hospitalisation due to an acute exacerbation of chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality10. Question Does low-dose theophylline reduce the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD) when added to inhaled corticosteroids?. Theophylline is the most commonly used methylxanthine, a non-selective phosphodiesterase inhibitor, originally used as a bronchodilator in COPD [ 4 ]. This study investigated the real-world use of methylxanthines in the management of AECOPD.Methods: Patient data from the Acute exacerbation of Chronic obstructive pulmonary disease . Theophylline level (if patient is on theophylline). COPD exacerbations. Five day course of 40 mg daily is sufficient for most COPD exacerbations. Japan is an aging society, and the number of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) is consequently increasing, with an estimated incidence of approximately 5 million.In 2014, asthma‐ COPD overlap syndrome (ACOS) was defined by a joint project of Global Initiative for Asthma (GINA) committee and the Global Initiative for Chronic Obstructive Lung Disease . Stage 1 - mild FEV1 > 80% predicted; FEV1/FVC <0.7 and symptomatic If this is correct this should improve symptoms, reduce exacerbations, and reduce the progression of the disease. Preclinical investigations have demonstrated that low plasma concentrations (1-5 mg/L) of theophylline enhance antiinflammatory effects of corticosteroids in COPD. . Theophylline is a long-acting bronchodilator. Oral theophylline has been used as a bronchodilator to treat airway diseases for over 80 years and is currently widely used in resource-limited countries [ 5 - 7 ]. Theophylline is no longer a first-line drug in the treatment of asthma or exacerbations of COPD; it is a second or third-line drug for this indication. In the paper by Cosio and colleagues on the effect of low-dose theophylline on the anti-inflammatory effects of steroids during exacerbations of chronic obstructive pulmonary disease (COPD), the . A small randomised placebo controlled trial in China demonstrated that doses of 100mg twice daily reduced exacerbations compared with placebo (Zhou 2006). Background and objectives: The burden of chronic obstructive pulmonary disease (COPD) disproportionately affects patients in low to middle-income countries. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Common differential diagnosis to consider include: Pneumonia, pneumothorax, pulmonary embolus No role for add-on theophylline to prevent COPD exacerbations Acute exacerbations of chronic obstructive pulmonary disease (COPD) are treated with oxygen (in hypoxemic patients), inhaled beta2 agonists, inhaled anticholinergics, antibiotics and systemic . the study aims to demonstrate that treatment with low dose oral prednisone and low dose, slow release theophylline compared to low dose, slow release theophylline only or placebo will reduce copd exacerbations and improve a range of secondary outcomes including quality of life, copd assessment test (cat) score, hospital admissions and lung … In Singapore, COPD is the tenth . Airway infection is also a key pathogenic mechanism of COPD exacerbations [13, 15, 17-19] which, are characterized by a flare-up of . indication. Theophylline is a bronchodilator, a type of medication that makes it easier to breathe. Audio Editors' Summary: Theophylline and COPD Exacerbations, Bariatric Surgery and Macrovascular Events, Review of VTE Management, and more Original Investigation Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD : A Randomized Clinical Trial Theophylline is a bronchodilator that's been used in the treatment of COPD for more than seven decades. Theophylline is derived from methylxanthine, naturally present in tea and cocoa beans. PDE-4 inhibitor (roflumilast) Minimizes risk of COPD exacerbation Brand names include Elixophyllin®, Theobid®, Theo-24®, T-phyl® and Uniphyl®. • All patients on Long Term Oxygen Therapy (LTOT) should be under the specialist oxygen service. medwireNews: The addition of low-dose theophylline to inhaled corticosteroids (ICS) does not reduce the risk of exacerbations among patients with chronic obstructive pulmonary disease (COPD), findings from the TWICS trial indicate.. As reported in JAMA, ICS-treated COPD patients with a smoking history of more than 10 pack-years and at least two exacerbations treated with antibiotics, oral . Theophylline may have a unique effect in the treatment of COPD by restoring reduced HDAC activity to normal levels, thus suppressing inflammation but also potentially making the patients responsive to corticosteroids. Importance: Chronic obstructive pulmonary disease (COPD) is a major global health issue and theophylline is used extensively. Severity grading has been recently updated (NICE CG101 2010) to bring into line with other international guidelines. Background: Although medical guidelines discourage the use of methylxanthines in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), they are still widely used in clinical practice. Background The highest burden of chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries. C 7 H 8 N 4 O 2 M.W. • Theophylline, a non-selective phosphodiesterase inhibitor, is an older medication that has significant side effects including headache, nausea and vomiting, restlessness and In Japan, theophylline is prescribed for most COPD patients (Ichinose et al 2006). Dr. In Portugal, hospitalizations due to COPD between 2009 and 2016 decreased by 8%, but they still represented 8049 hospitalized patients in 2016. Theophylline •Consider the addition of theophylline MR 200mg - 400mg twice daily (as Uniphyllin® Exacerbation Guidelines. The COPD severity is worsening. Methods In this randomised, three-arm, double-blind, double-dummy, placebo-controlled study conducted in 37 centres in China, symptomatic patients with moderate to very severe COPD . This product allows a 12-hour dosing interval for a majority of patients and a 24-hour dosing interval for selected patients (see DOSAGE AND ADMINISTRATION section for description of appropriate patient populations).. Each extended-release tablet for oral administration contains either 300 mg or 450 mg of Theophylline anhydrous, USP. Evidence to suggest that aminophylline should not be used in mild to moderate COPD exacerbations Theophylline is one of those medications that has intrigued and possibly confused clinicians and pharmacologists alike since the mid 19th century.

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