Brenner M, Berkowitz R, Marshall N, Strunk R C
Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO 80206.
Clin Allergy. 1988 Mar;18(2):143-50. doi: 10.1111/j.1365-2222.1988.tb02853.x.
Concern about side-effects of theophylline prompted us to investigate whether this drug could be eliminated from the multi-medication regimen of severe asthmatics. We studied patients with a demonstrated requirement for systemic steroids who were taking most other available anti-asthma medications in an attempt to reduce systemic steroids while maintaining clinical stability. Five in-patients, 12-15 years old, completed a double-blind, cross-over trial of theophylline vs placebo. All were stable for 4 weeks prior to the study with normal spirometry and mildly elevated lung volumes. Regular medications consisted of long-acting theophylline with levels between 12 mcg/ml and 16 mcg/ml, and prednisone 10-30 mg on alternate days. In addition, they were all taking inhaled metaproterenol, cromolyn sodium, atropine sulphate, and beclomethasone dipropionate four times daily (qid). Patients received either theophylline or placebo during two drug periods. All other medications were unchanged. Parameters measured were symptom score, number of extra respiratory treatments (prn RTs), increase in steroid dosage, and daily spirometry. During the placebo period, all five patients required increased steroids, daily spirometry decreased and three patients developed severe exacerbations unrelated to viral infection. A marked increase in symptom score occurred within 48 hr of discontinuing theophylline in all. These findings emphasize that theophylline is beneficial in a subset of severe asthmatics who cannot be controlled with all other available bronchodilators, cromolyn, and inhaled and systemic steroids.
对茶碱副作用的担忧促使我们研究这种药物是否可以从重度哮喘患者的多种药物治疗方案中去除。我们研究了那些已证明需要全身性类固醇治疗的患者，他们正在服用大多数其他可用的抗哮喘药物，试图在维持临床稳定的同时减少全身性类固醇的用量。5名年龄在12至15岁的住院患者完成了一项关于茶碱与安慰剂的双盲交叉试验。在研究前，所有患者均稳定4周，肺功能正常，肺容量轻度升高。常规药物包括长效茶碱，血药浓度在12微克/毫升至16微克/毫升之间，以及隔日服用10至30毫克泼尼松。此外，他们都每天4次吸入间羟异丙肾上腺素、色甘酸钠、硫酸阿托品和二丙酸倍氯米松。患者在两个药物治疗期分别接受茶碱或安慰剂。所有其他药物均保持不变。测量的参数包括症状评分、额外呼吸治疗的次数（按需治疗）、类固醇剂量的增加以及每日肺功能测定。在安慰剂治疗期，所有5名患者都需要增加类固醇用量，每日肺功能测定结果下降，3名患者出现与病毒感染无关的严重病情加重。在所有患者停用茶碱后的48小时内，症状评分均显著增加。这些发现强调，茶碱对一部分无法用所有其他可用的支气管扩张剂、色甘酸钠以及吸入和全身性类固醇控制的重度哮喘患者有益。
