Chronic obstructive lung disease: a role for theophylline?

ABSTRACT

Asthma, chronic obstructive bronchitis, and emphysema represent different forms of chronic obstructive pulmonary disease (COPD). Because they have different causes and are based on different pathophysiology, it is reasonable to suspect they may respond differently to treatment. In particular, bronchodilators, such as theophylline, which are purported to act by preventing the spasm of bronchial smooth muscle, should work in asthma but not in chronic bronchitis or emphysema. However, theophylline and other bronchodilators do improve breathing in all three forms of COPD, although to different degrees. Theophylline's effectiveness in chronic bronchitis and emphysema is attributed, in part, to the observation that these forms of COPD commonly have a reversible component (bronchospastic). Furthermore, it is now known that theophylline's mechanism of action includes a strengthening of the diaphragm and other muscles of respiration. These additional mechanisms may explain theophylline's effectiveness in those forms of COPD that lack a bronchospastic component. (AU)