Anna Liachenko, BSc, MSc

The popularity of theophylline, a bronchodilator used in the treatment of asthma and other bronchospastic diseases for over 60 years, has been declining due to its narrow therapeutic index and the perceived lack of anti-inflammatory effects. Instead, newer therapies, such as inhaled long-acting corticosteroids, have been increasingly recommended. Although valued for their anti-inflammatory properties, these newer therapies can nevertheless produce serious side effects at therapeutic concentrations. Fortunately, the prescribed dosages can be decreased due to the recently discovered anti-inflammatory properties of theophylline, which is now recommended as an add-on therapy to corticosteroids. In this article, the beneficial effects and necessary precautions when using theophylline are examined, with particular emphasis on the elderly.

In Canada, theophylline is currently indicated for the symptomatic treatment of reversible bronchospasm associated with asthma, chronic bronchitis, emphysema, and associated bronchospastic disorders. Historically, asthma was treated mainly with bronchodilators. During the 1980s it became apparent that an unacceptably high rate of asthma-related hospitalizations and asthma deaths were partly attributed to the under-use of anti-inflammatory medications. For this reason, the use of inhaled corticosteroids increased. Unfortunately, there is some systemic absorption of inhaled corticosteroids.