China
Africa
Explore chapters and articles related to this topic
Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
After two or three doses of epinephrine or inhaled beta-agonists, if the wheezing is not corrected, then intravenous theophylline may be indicated. Dosing should be based on theophylline serum levels, if the patient has been receiving oral theophylline. It should be noted that theophylline requirements decrease as pregnancy advances because pharmacokinetic parameters are counterintuitively altered in pregnancy. The patient should be admitted to the hospital if she demonstrates a poor spirometric response to therapy, has no symptom improvement, or has pneumonia or pneumothorax.
Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Theophylline has a long record of use in pregnancy and no teratogenic effects are known; however, the narrow therapeutic window and potential for maternal and fetal toxicity mandates close monitoring of serum levels. Low-dose theophylline is an alternative to a LABA when inhaled corticosteroids do not suffice to control symptoms, but this is not a preferred therapy [2]. GINA guidelines now recommend against the regular use of theophylline.
Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Airway inflammation is treated with inhaled corticosteroids and bronchial hyper-responsiveness is treated with short- or long-acting bronchodilators. In addition, leukotriene receptor antagonists, theophylline, and cromolyn appear to be safe during pregnancy and may be considered in select patients (21). Most data on the safety of asthma medications in pregnancy are observational, with the most extensively studied being albuterol and inhaled budesonide (21–23). Albuterol appears to be safe based on a review of six published studies including 1599 women and a prospective study including 1828 women, in whom no significant relationship was found between the use of inhaled beta-2 agonists and adverse pregnancy outcomes (21,24). The National Asthma Education and Prevention Program Working Group reviewed 10 studies, including 6113 patients who were treated with inhaled corticosteroids during pregnancy and found no increases in congenital malformations or adverse perinatal outcomes in these patients (24).
Glycopyrrolate and formoterol fumarate for the treatment of COPD
Published in Expert Review of Respiratory Medicine, 2021
Pierre-Edouard Grillet, Cosette Le Souder, Juliette Rohou, Olivier Cazorla, Jérémy Charriot, Arnaud Bourdin
Managing COPD in 2020 mostly relies on non-pharmacological aspects such as rehabilitation, smoking cessation, vaccines, oxygen supplementation when appropriate (and this should be cautiously weighed nowadays) and lung volume reduction when feasible. Most of the pharmacological goals target lung function, quality of life, and reduction of the exacerbation rates. The latter is now progressively better understood with the recognition that some T2 patterns can be evidenced in a subset of COPD patients, leading to studies assessing the benefits of T2-targeting biologics that are already approved in asthma [4]; long-term macrolides may also be recommended. Theophylline used to be recommended as a bronchodilator and has some anti-inflammatory effects, though anti-inflammatory potency is greater with modern phosphodiesterase 4 inhibitors. Table 1 summarizes the currently available therapeutic options, the current unmet needs and related outcomes. Although it would be difficult to compile all available data and decide whether or not post hoc studies or meta-analysis and other study types should be taken into account, the main objective of this table is highlighting to which extent currently available options cover the real unmet need in COPD.
The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)
Published in Expert Opinion on Pharmacotherapy, 2020
Timothy E. Albertson, James A. Chenoweth, Skyler J. Pearson, Susan Murin
Similar to the use in COPD, theophylline has been used in the treatment of acute exacerbations and in the chronic maintenance therapy of asthma [93]. Its utility after systemic steroids and intensive inhaled SABA and SAMA therapy is limited [93]. Clinical trials have confirmed the effectiveness of theophylline in severe asthmatics and demonstrate a deterioration in lung function and worsening symptoms with its removal [93]. It is less effective than inhaled therapy in asthma but is less expensive so its use in treating asthma world-wide is still significant. A recent meta-analysis on the efficacy and side effects of intravenous theophylline in acute asthma from 42 individual trials demonstrated similar efficacy and rate of side effects at a much lower cost than other drugs used for acute asthma [95]. When low-dose theophylline was added and compared to increasing the dose of ICS, a recent Chinese trial demonstrated similar therapeutic lung function improvement in symptomatic asthma patients [96]. A pooled analysis of data from two randomized controlled trials of asthma patients (DOROTHEO1 and DOROTHEO2) found that theophylline and another methylxantine doxofylline demonstrated increased FEV1, reduced exacerbations and reduced the use of inhaled SABA rescue inhaler compared to placebo [97]. The adverse events were statistically P < 0.05 more frequent with theophylline use than with placebo though adverse events were not statistically increased with doxofylline use compared to placebo [97].
Diaphragmatic recovery in rats with cervical spinal cord injury induced by a theophylline nanoconjugate: Challenges for clinical use
Published in The Journal of Spinal Cord Medicine, 2019
Fangchao Liu, Yanhua Zhang, Janelle Schafer, Guangzhao Mao, Harry G. Goshgarian
Clinical use of theophylline in man has been reported as early as 1922.9 However, there is limited documentation of clinical studies that investigate the use of systemically administered theophylline in humans following SCI to increase respiratory drive.10–12 In humans, the therapeutic dose of methylxanthines, including theophylline, can cause intolerable side effects including nausea, vomiting, nervousness, increased or irregular heartbeat, and insomnia.1,12,13 The side effects are caused by a high concentration of the drug in the plasma leading to global phosphodiesterase inhibition and adenosine A1-receptor antagonism resulting in a hyperactive state of many non-respiratory neurons.13 Further efforts to investigate the clinical outcome of systemic theophylline administration have been abandoned due to intolerable side effects and lack of quality data. An alternative method to administer theophylline is also needed. The ability to target theophylline to select respiratory nuclei has the potential to greatly reduce the systemic therapeutic dose and to reduce or eliminate unwanted side effects.