1
|
Boylan PM, Abdalla M, Bissell B, Malesker MA, Santibañez M, Smith Z. Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network. Pharmacotherapy 2023; 43:963-990. [PMID: 37423768 DOI: 10.1002/phar.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 07/11/2023]
Abstract
Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.
Collapse
Affiliation(s)
- Paul M Boylan
- Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City, Oklahoma, USA
| | - Maha Abdalla
- Department of Pharmaceutical Sciences, South College, School of Pharmacy, Knoxville, Tennessee, USA
| | - Brittany Bissell
- Department of Pharmacy Practice and Science, The University of Kentucky, College of Pharmacy, Lexington, Kentucky, USA
| | - Mark A Malesker
- Department of Pharmacy Practice, Creighton University, School of Pharmacy and Health Professions, Omaha, Nebraska, USA
| | - Melissa Santibañez
- Department of Pharmacy Practice, Nova Southeastern University, College of Pharmacy, Fort Lauderdale, Florida, USA
| | - Zachary Smith
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
2
|
Huang K, Guo Y, Kang J, An L, Zheng Z, Ma L, Peng L, Wang H, Su R, Itoh Y, Wang C. The efficacy of adding budesonide/formoterol to ipratropium plus theophylline in managing severe chronic obstructive pulmonary disease: an open-label, randomized study in China. Ther Adv Respir Dis 2019; 13:1753466619853500. [PMID: 31240995 PMCID: PMC6595664 DOI: 10.1177/1753466619853500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients diagnosed with chronic obstructive pulmonary disease (COPD) in China are commonly prescribed ipratropium plus theophylline (I+T) therapy. Studies have shown that an inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination is also efficacious in reducing symptoms and exacerbations. This study evaluated the efficacy and tolerability of adding budesonide/formoterol (BUD/FORM) to I+T in Chinese patients with severe COPD. METHODS A randomized, parallel-group, open-label, multicenter phase IV study (Clinical Trials.gov identifier: NCT01415518) was conducted in China. Patients received either BUD/FORM (160/4.5 µg; two inhalations twice daily [bid] via Turbuhaler®) + I (20 µg per inhalation, two inhalations four times daily) + T (100 mg bid) or I+T alone for 12 weeks. The primary efficacy variable was change from baseline in predose forced expiratory volume in 1 s (FEV1). RESULTS A total of 584 patients were randomized equally between treatment groups. At the end of the study, the BUD/FORM plus I+T group displayed significant improvements in predose FEV1 versus the I+T group (between-group difference 6.9%; 95% confidence interval [CI]: 4.3, 9.6; p < 0.0001). Forced vital capacity, inspiratory capacity, peak expiratory flow and health-related quality of life (HRQoL) scores were significantly improved (all p < 0.0001) and exacerbation frequency was reduced (43.5% reduction; rate ratio 0.565, 95% CI 0.325, 0.981; p = 0.0425) with BUD/FORM plus I+T versus I+T alone. CONCLUSION Patients with severe COPD in China treated with BUD/FORM plus I+T showed significant improvements in lung function and HRQoL and a reduction in exacerbations compared with I+T alone. Both treatments were well tolerated and no safety concerns were noted. The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Kewu Huang
- Department of Pulmonary and Critical Care
Medicine, Beijing Chao-Yang Hospital, Capital Medical University,
China
- Beijing Institute of Respiratory Medicine,
China
| | - Yanfei Guo
- Department of Pulmonary and Critical Care
Medicine, Beijing Hospital, Ministry of Health, Dongdan, China
| | - Jian Kang
- The First Hospital of China Medical University,
Heping, Shenyang, China
| | - Li An
- Department of Pulmonary and Critical Care
Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing,
China
- Beijing Institute of Respiratory Medicine,
China
| | - Zeguang Zheng
- The First Affiliated Hospital of Guangzhou
Medical University, Yuexiu, China
| | - Lijun Ma
- Henan Provincial People’s Hospital, Zhengzhou,
China
| | - Liping Peng
- Jilin University First Hospital, Changchun,
China
| | - Hongyang Wang
- Hebei United University Affiliated Hospital,
Tangshan, China
| | - Rong Su
- Global Medicines Development, AstraZeneca,
Shanghai, China
| | | | - Chen Wang
- Department of Pulmonary and Critical Care
Medicine, Beijing Hospital, China
- Department of Pulmonary and Critical Care
Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital,
Beijing, China
- National Clinical Research Center for
Respiratory Diseases, Beijing, China
- Department of Respiratory Medicine, Capital
Medical University, Beijing, China
- Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
| |
Collapse
|
3
|
Korkmaz Ekren P, Gürgün A, Elmas Uysal F, Tuncel Ş, Deniz S, Karapolat H, Bacakoğlu F. Effects of pulmonary rehabilitation in patients with mild-to-moderate chronic obstructive pulmonary disease: Bottom of an iceberg. Turk J Phys Med Rehabil 2018; 64:162-169. [PMID: 31453507 PMCID: PMC6657762 DOI: 10.5606/tftrd.2018.1006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 06/21/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to compare the effects of pulmonary rehabilitation (PR) in patients with mild-to-moderate and severe-to-very severe chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS Between January 2005 and December 2010, a total of 76 patients with mild-to-moderate (Global Initiative for Chronic Obstructive Lung Disease [GOLD] Stages I+II, n=33, mean age 66.0±8.6 years) and severe-to-very severe (GOLD Stages III+IV, n=43, mean age 63.5±8.8 years) COPD completed an eight-week outpatient PR program. Incremental and endurance shuttle walk tests (ISWT, ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression Scale were assessed before and after PR. Changes after the intervention were compared between two groups. RESULTS There were significant improvements in the ISWT and median 60 m [(-150)-(400)] in mild-to-moderate group and 70 m [(0)-(270)] in severe-to-very severe group (both, p<0.001). The ESWT time improved in both groups, 122s [(-279)-(665)] (p=0.002) and 61s [(-180)- (878)] (p<0.001), respectively. Significant effects were observed in all domains of the SGRQ except the impact score in mild-to-moderate patients. There were significant improvements in all domains except the symptoms score in severe-to-very severe patients. Using the CRQ, a significant improvement was shown in all domains of CRQ except the dyspnea score of mild-to-moderate patients. Anxiety and depression scores decreased after PR in both groups (p<0.05). According to changes in outcomes, there was no difference in any parameters between two groups. CONCLUSION This study demonstrates that patients with mild-to-moderate COPD benefit from PR comparably to patients with severe-to- very-severe COPD. Although patients with mild-to-moderate COPD are not usually symptomatic, our findings suggest that they should be included in PR.
Collapse
Affiliation(s)
| | - Alev Gürgün
- Department of Chest Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Funda Elmas Uysal
- Department of Chest Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Şenay Tuncel
- Department of Chest Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sami Deniz
- Department of Chest Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hale Karapolat
- Department of Physical Therapy and Rehabilitation, Ege University Faculty of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Department of Chest Diseases, Ege University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
4
|
Gurgun A, Deniz S, Argın M, Karapolat H. Effects of nutritional supplementation combined with conventional pulmonary rehabilitation in muscle-wasted chronic obstructive pulmonary disease: A prospective, randomized and controlled study. Respirology 2013; 18:495-500. [DOI: 10.1111/resp.12019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 08/30/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Alev Gurgun
- Department of Chest Diseases; Ege University School of Medicine; Izmir; Turkey
| | - Sami Deniz
- Department of Chest Diseases; Ege University School of Medicine; Izmir; Turkey
| | - Mehmet Argın
- Department of Radiology; Ege University School of Medicine; Izmir; Turkey
| | - Hale Karapolat
- Department of Physical Therapy and Rehabilitation; Ege University School of Medicine; Izmir; Turkey
| |
Collapse
|
5
|
Berger WE, Nadel JA. Efficacy and safety of formoterol for the treatment of chronic obstructive pulmonary disease. Respir Med 2007; 102:173-88. [PMID: 18023995 DOI: 10.1016/j.rmed.2007.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 09/24/2007] [Indexed: 11/19/2022]
Abstract
Formoterol is a selective long-acting beta2-adrenergic receptor agonist (LABA) that provides significant and sustained bronchodilatory effect for up to 12h following a single dose. The onset of effect is significantly faster with formoterol compared with an alternative LABA, salmeterol, although both have a similar duration of action. The overall efficacy of formoterol in improving lung function and controlling symptoms of chronic obstructive pulmonary disease (COPD) is comparable to that of salmeterol and potentially superior to that of ipratropium or theophylline. Formoterol provides additional benefit when administered in combination with other bronchodilators or inhaled corticosteroids. In clinical studies, formoterol was well tolerated and had an adverse-event profile similar to that of other beta2-adrenergic receptor agonists. Formoterol is a rapidly acting, well-tolerated, effective beta2-adrenergic receptor agonist that can be regularly used as a long-acting bronchodilator for patients with moderate to severe COPD, as per recommendations of the current treatment guidelines.
Collapse
Affiliation(s)
- W E Berger
- Allergy and Asthma Associates of Southern California, 27800 Medical Asthma Associates, Suite 244, Mission Viejo, CA 92691, USA.
| | | |
Collapse
|
6
|
Cazzola M, Gabriella Matera M. The additive effect of theophylline on a combination of formoterol and tiotropium in stable COPD: A pilot study. Respir Med 2007; 101:957-62. [PMID: 17056241 DOI: 10.1016/j.rmed.2006.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 09/09/2006] [Indexed: 11/18/2022]
Abstract
We explored the additive effect of titrated oral theophylline in patients with stable chronic obstructive pulmonary disease (COPD) who received both tiotropium, 18mug od, and formoterol, 12mug bid. Thirty-six patients with moderate-to-severe COPD were enrolled in this two-period trial. They were initially treated with formoterol+tiotropium for 4 weeks. After this first period, they were divided in two groups of 18 patients. Both groups continued with the initial treatment for further 4 weeks, but the first group received also placebo whereas the second group received oral theophylline. The combination therapy with formoterol+tiotropium induced a significant improvement in mean predose FEV(1) and FVC at the end of the first period, and a significant reduction in dyspnea score as measure by a visual analogic scale and in use of rescue salbutamol. The second period of treatment elicited a significant further improvement in lung function and reduction in dyspnea score and salbutamol use in both groups. On the contrary, differences in improvements in FEV(1) and FVC and reduction in dyspnea score and salbutamol use between theophylline and placebo arms at the end of the second treatment period were not significant, although 5 patients reported an important relief in dyspnea during the theophylline administration period. These findings question the importance of adding theophylline in stable COPD patients already treated with two long-acting bronchodilators, but also indicate the possibility that some of them can benefit from theophylline because of a symptomatic improvement.
Collapse
Affiliation(s)
- Mario Cazzola
- Department of Respiratory Medicine, Unit of Pneumology and Allergology, A. Cardarelli Hospital, Naples, Italy.
| | | |
Collapse
|