Newman D, Tamir J, Speedy L, Newman J P, Ben-Dov I
Department of Medicine, Hadassah University Hospital, Jerusalem, Israel.
Isr J Med Sci. 1994 Nov;30(11):811-6.
The effect of oral theophylline on clinical course, exercise, neuropsychological performance and bronchial reactivity was studied in chronic airflow obstruction. Twelve patients with chronic obstructive pulmonary disease (COPD) [mean age 62.4 +/- 1.6 years (SE), and forced expiratory volume in 1 sec of 1.15 +/- 0.1 l] were randomized to 4 weeks treatment with oral theophylline followed by 4 weeks of placebo, in a double-blind fashion. During each period, patients underwent clinical evaluation, incremental exercise, a battery of neuropsychological tests measuring a wide range of cognitive functions, and an inhaled methacholine provocation. On the active drug (levels 9.5 +/- 1 mg/l), vital capacity and maximal breathing capacity were 16 +/- 7% and 20 +/- 7% respectively, higher relative to placebo (P < 0.04). Exercise capacity, as reflected by peak O2 uptake and the anaerobic threshold, improved 14 +/- 5% and 18 +/- 5% (P < 0.04). In contrast, bronchial responsiveness to inhaled methacholine and the mean scores on the neuropsychological tests were not significantly altered by the drug. Clinical symptoms were unaltered, but mild side effects were more common on theophylline. We concluded that in moderate to severe COPD, theophylline treatment, at the low range of the therapeutic dose, improves lung function and exercise capacity. This improvement is achieved with no detectable alteration of bronchial reactivity to methacholine and with no deleterious effect on cognitive functions.
研究了口服茶碱对慢性气流阻塞患者临床病程、运动能力、神经心理表现和支气管反应性的影响。12例慢性阻塞性肺疾病（COPD）患者[平均年龄62.4±1.6岁（标准误），第1秒用力呼气量为1.15±0.1升]，以双盲方式随机接受4周口服茶碱治疗，随后4周接受安慰剂治疗。在每个阶段，患者接受临床评估、递增运动、一系列测量广泛认知功能的神经心理测试以及吸入乙酰甲胆碱激发试验。服用活性药物（血药浓度9.5±1毫克/升）时，肺活量和最大通气量相对于安慰剂分别提高了16±7%和20±7%（P<0.04）。以峰值摄氧量和无氧阈值反映的运动能力分别提高了14±5%和18±5%（P<0.04）。相比之下，药物对吸入乙酰甲胆碱的支气管反应性和神经心理测试的平均得分没有显著改变。临床症状未改变，但茶碱治疗时轻微副作用更常见。我们得出结论，在中度至重度COPD患者中，低治疗剂量范围的茶碱治疗可改善肺功能和运动能力。这种改善在未检测到对乙酰甲胆碱的支气管反应性改变且对认知功能无有害影响的情况下实现。
