Johnston I D
University Hospital, Nottingham.
BMJ. 1990 Apr 7;300(6729):929-31. doi: 10.1136/bmj.300.6729.929.
The narrow therapeutic index, potential toxicity, and need to monitor plasma concentrations make theophyllines difficult to use. Other drugs provide comparable or better bronchodilator and prophylactic efficacy. In asthma theophyllines should be considered for chronic stable asthma when treatment with optimal doses of inhaled steroids and bronchodilators fails to provide adequate control; for nocturnal asthma; and for prophylaxis and relief of symptoms in children and adults when inhaled treatment cannot be given. In general, theophyllines cannot be recommended for chronic airflow obstruction. A trial of theophylline is reasonable in individual patients whose symptoms remain troublesome despite a trial of steroids and optimal doses of inhaled bronchodilators.
治疗指数窄、潜在毒性以及需要监测血药浓度使得茶碱类药物难以使用。其他药物具有相当或更好的支气管扩张和预防效果。在哮喘治疗中，当使用最佳剂量的吸入性糖皮质激素和支气管扩张剂治疗未能提供充分控制时，对于慢性稳定型哮喘、夜间哮喘以及在无法进行吸入治疗时用于儿童和成人的症状预防及缓解，可考虑使用茶碱类药物。一般而言，不推荐将茶碱类药物用于慢性气流受限。对于那些尽管试用了糖皮质激素和最佳剂量的吸入性支气管扩张剂但症状仍困扰的个体患者，试用茶碱类药物是合理的。
