Vaz Fragoso C A, Miller M A
Pulmonary and Critical Care Section, Danbury Hospital, CT 06810.
Am Rev Respir Dis. 1993 Jun;147(6 Pt 2):S40-7. doi: 10.1164/ajrccm/147.6_Pt_2.S40.
Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and mortality. Therapeutic options are few and are often limited in efficacy. Theophylline is one option, but its use appears to have recently reached a threshold point of deemphasis. Given the consequences of further diminishing the available treatment of COPD, a reappraisal of theophylline's role is imperative. This report reviews the clinical efficacy of theophylline in managing patients with COPD. Special consideration is given to theophylline's effects on pulmonary function (i.e., bronchodilation, exercise capacity, and gas exchange), dyspnea, mucociliary clearance, respiratory muscle performance, cardiovascular function, and neuroinspiratory drive. Despite the lack of standardization in study design and methodology among the studies evaluating theophylline, the conflicting results, and the questions that remain to be answered, evidence indicates that theophylline can provide meaningful therapeutic benefit to patients with COPD. In addition, several studies in patients with COPD have shown that theophylline and inhaled beta-agonists interact in an additive fashion, and the combination therapy results in additional objective and subjective improvement over that achieved by either preparation alone.
慢性阻塞性肺疾病（COPD）与严重的发病率和死亡率相关。治疗选择很少，且疗效往往有限。茶碱是一种选择，但最近其使用似乎已达到不再受重视的临界点。鉴于进一步减少COPD现有治疗方法的后果，重新评估茶碱的作用势在必行。本报告回顾了茶碱在治疗COPD患者中的临床疗效。特别考虑了茶碱对肺功能（即支气管扩张、运动能力和气体交换）、呼吸困难、黏液纤毛清除、呼吸肌功能、心血管功能和神经吸气驱动的影响。尽管在评估茶碱的研究中，研究设计和方法缺乏标准化，结果相互矛盾，仍有一些问题有待解答，但有证据表明，茶碱可为COPD患者提供有意义的治疗益处。此外，多项针对COPD患者的研究表明，茶碱与吸入型β受体激动剂具有相加作用，联合治疗比单独使用任何一种制剂都能带来额外的客观和主观改善。
