What is the role of methylxanthines in the treatment of chronic obstructive pulmonary disease (COPD)?

Updated: Nov 13, 2020
  • Author: Paul Kleinschmidt, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

These agents (eg, theophylline) increase collateral ventilation, respiratory muscle function, mucociliary clearance, and central respiratory drive. Despite this, many questions exist as to their true efficacy, and they have no real role in the acute exacerbation of COPD, except to increase the risk of adverse effects. [13] Patients may subjectively feel better, but no data suggest any real change in measureable outcomes or disease progression.

In general, if the patient is already on theophylline and has a subtherapeutic level, a mini-loading dose could be considered but is certainly not considered first-line therapy. If the patient is not on theophylline, the delay before benefit of the oral form makes it not worth using. Intravenous aminophylline has a propensity to cause arrhythmias, especially in a population that already has cholinergic excess coupled with coronary disease.


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