Theophylline use: an overview.

Four critical issues related to theophylline are addressed: What is theophylline? Why use it? How should it be used? Who should receive it? Theophylline is a methylated xanthine with established clinical benefit as maintenance therapy for chronic asthma. In fact, evolution of our knowledge of the pharmacodynamics and pharmacokinetics of theophylline has made this drug the most effective nonsteroidal prophylactic used for chronic asthma. Theophylline has the potential for serious toxicity at excessive serum concentrations. Nonetheless, its major justification for use today, when so many other asthma medications have become available, is because of the high degree of efficacy that can be attained with appropriate use. The optimal likelihood of maximal safe effect is attained with maintenance of serum concentrations within the 10 to 20 micrograms/ml therapeutic range. Dosage should be individualized by clinical titration, guided by measurement of serum concentrations, and continued only if well tolerated; selection of appropriate products and dosing intervals permits maintenance of acceptably stable serum concentrations. Asthma in patients only intermittently symptomatic, regardless of severity, is probably best treated by intervention measures with inhaled bronchodilators, supplemented when necessary by short-term use of oral corticosteroids, rather than by long-term maintenance therapy. Theophylline therapy in patients with obstructive pulmonary disease other than asthma should generally be highly selective and based on clearly demonstrable clinical benefit.