Should we stop using theophylline for the treatment of the hospitalized patient with status asthmaticus?

Recent reviews and editorials have indicated that theophylline may not be effective for the therapy of acute severe asthma. This judgment is primarily based on data comparing the efficacy of theophylline to inhaled beta 2-agonists in the emergency room treatment of asthma. The authors believe that it is inappropriate to extrapolate data from short-term studies in the emergency room setting to the hospitalized patients with status asthmaticus. Studies of hospitalized patients in which the patients were monitored for at least 24 hours all demonstrate a positive therapeutic effect for theophylline. The possible reasons for the discrepancies between hospitalized patients and emergency room patients are discussed. Theophylline is still recommended for the management of the hospitalized patient with status asthmaticus.