Theophylline for long-term control of asthma

Examples

Theophylline is available as pills, capsules, liquid, and injection. Slow-release (sustained-release) forms can be given 1 or 2 times a day.

How It Works

Theophylline is a methylxanthine. Sustained-release methylxanthine medications are used to control inflammation in the airways in the lungs (bronchial tubes). Short-acting methylxanthine medications are used to control narrowing of the bronchial tubes. This may decrease asthma symptoms.

Why It Is Used

Theophylline is used in mild-to-moderate persistent asthma. It is usually used with an inhaled corticosteroid. It can be used by itself or with an inhaled corticosteroid to control symptoms at night.

On rare occasions, theophylline may be used instead of other asthma medication:

• In small children who would have trouble using an inhaler
• In people who are more likely to take a medication by mouth than by inhaler
• As added medication for people whose asthma is not controlled with an inhaled corticosteroid

Different types of medications are often used together in the treatment of asthma. Medication treatment for asthma depends on a person's age, his or her type of asthma, and how well the treatment is controlling asthma symptoms.

• Children up to age 4 are usually treated a little differently than those 5 to 11 years old.
• The least amount of medicine that controls the asthma symptoms is used.
• The amount of medicine and number of medicines are increased in steps. So if asthma is not controlled at a low dose of one controller medicine, the dose may be increased. Or another medicine may be added.
• If the asthma has been under control for several months at a certain dose of medicine, the dose may be reduced. This can help find the least amount of medicine that will control the asthma.
• Quick-relief medicine is used to treat asthma attacks. But if you or your child needs to use quick-relief medicine a lot, the amount and number of controller medicines may be changed.

Your doctor will work with you to help find the number and dose of medicines that work best.

How Well It Works

One study showed that in adults with uncontrolled mild-to-moderate persistent asthma, lung function improved when theophylline was added to an inhaled corticosteroid.¹

Side Effects

Side effects of methylxanthines may include:

• Nausea, vomiting, heartburn, and diarrhea.
• Headache and irritability.
• Sleep problems (insomnia).
• Rapid heart rate (tachycardia), which may become life-threatening.
• Rapid breathing (tachypnea).
• Seizures in adults.
• Overactivity in children.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Theophylline is considered an alternative medication for persistent asthma in adults. Inhaled corticosteroids are preferred. It is also considered an alternative addition to inhaled corticosteroids in moderate persistent asthma in children and adults. Long-acting inhaled beta2-agonists are the preferred addition to inhaled corticosteroids.²

Many other medications (such as antibiotics, medications to control stomach acid, birth control pills, medications to calm people, heart medications, and seizure medications), alcohol, and some medical conditions can affect the levels of theophylline in the blood. High blood levels of theophylline cause increased side effects.

Because theophylline interacts with many different medications, tell your doctor about all medications you are taking. Your doctor also will check the level of theophylline in your blood regularly to make sure it is not too high.

Babies are especially at risk for developing high levels of theophylline in the blood, so they need their blood levels checked regularly. Slow-release theophylline has an even greater risk for causing side effects than the short-acting medication.

In the early 1990s, there were reports that theophylline could affect learning and behavior (such as causing hyperactivity) in children. When the medication level in the blood is within a safe range, theophylline has not been shown to affect learning.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

1. Dennis RJ, et al. (2005). Asthma, search date May 2004. Online version of Clinical Evidence (14): 1847-1877.

2. National Institutes of Health (2007). National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 08-5846). Available online: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

Credits