In spite of contradictory evidence, the use of low-dose theophylline (plasma concentration 1–5 mg/L) in COPD has received attention owing to its potential synergism with inhaled corticosteroids.

Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: a Randomized Clinical Trial Source: Cochrane Central Register of Controlled Trials - 16 October 2018 - …

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Although theophylline has side effects when used in bronchodilator doses, increasing evidence shows that it has significant antiinflammatory effects in chronic obstructive pulmonary disease at lower plasma concentrations.

In many industrialized countries, the frequency of side effects and the relatively low efficacy of theophylline have led to reduced usage, because inhaled βIn international guidelines, theophylline has been relegated to third-line therapy in COPD (When theophylline was introduced into asthma therapy, it was used as a bronchodilator, and early dose–response studies showed an increasing acute bronchodilator response above plasma concentrations of 10 mg/L (55 μM).

The upper recommended plasma concentration was set at 20 mg/L because of unacceptable side effects above this level.

A post bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) of less than 0.7 on spirometry confirms persistent airflow obstruction. Tralokinumab unsuccessful for management of severe, uncontrolled asthma Theophylline directly relaxes human airway smooth muscle There is increasing evidence that theophylline has antiinflammatory effects in asthma and COPD (Although theophylline has been in clinical use for many years, its mechanism of action at a molecular level and its site of action remain uncertain (Theophylline is a weak and nonselective inhibitor of PDEs, which break down cyclic nucleotides in the cell, thereby leading to an increase in intracellular cAMP and cGMP concentrations.

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Its non-bronchodilator effects suppress the response of the airways to stimuli.

This seems unlikely given the number of participants required for an adequately powered study in this select subgroup. Copyright

RCT (n=1578) found in people with COPD at high risk of exacerbation (EX), addition of low-dose oral theophylline to drug regimen that includes inhaled corticosteroids confers no overall clinical...