Beneficios clínicos y funcionales de agregar teofilina a la terapia inhalatoria con broncodilatadores de acción corta en pacientes con enfermedad pulmonar obstructiva crónica / Clinical and functional benefits of adding theophylline to a standard treatment with short acting bronchodilators in patients with COPD

Background: Although theophylline is considered a third line bronchodilator drug for the treatment of chronic obstructive pulmonary disease (COPD), it is widely used in Chile, because it is administered orally and has a moderate cost. Aim: To evaluate if theophylline adds clinical and/or functional benefits when associated to standard recommended inhaled bronchodilator therapy. Subjects and methods: Thirty-eight stable COPD patients who accepted to participate in the study approved by the Ethics Committee of our institution were studied. Using a randomized double-blind placebo-controlled study, theophylline (250 mg) or placebo was administered twice a day for 15 days in addition to inhaled salbutamol and ipratropium bromide. Prior to and at the end of the study, patients underwent: a) a spirometry to evaluate changes in dynamic pulmonary hyperinflation using slow vital capacity (SVC) and inspiratory capacity (IC), b) the 6 min walking distance (6 MWD); and c) measurement of maximal inspiratory and expiratory pressures. Dyspnea and quality of life (QoL) were evaluated using appropriate questionnaires. Results: Compared to placebo, patients on theophylline showed significant increases in SVC (p=0.014), IC (p=0.002), and 6 MWD (p=0.005). They also experienced an improvement in dyspnea (p=0.042) and QoL (p=0.011). All patients improved at least one of these parameters with 53% of the patients showing an improvement in 3 or more. Conclusions: Our results indicate that adding theophylline to standard treatment with inhaled bronchodilators provides additional benefits in stable COPD patients by reducing dynamic pulmonary hyperinflation, improving exercise tolerance, dyspnea and QoL.

Inalaçao da combinaçao fenoterol e brometo de ipratropio na terapeutica de longa duraçao da obstruçao reversivel das vias aereas / Inhalation of fenoterol and ipratropium bromite combination in long-term therapeutic of airways reversible obstruction

Quatorze pacientes ambulatoriais portadores de bronquite cronica (n=5) ou asma bronquica (n=9) foram admitidos em um ensaio desenhado para avaliar o efeito da inalaçao combinada de fenoterol 200 ug + brometo de ipratropio 80 ug via aerossol pressurizado tres vezes ao dia por um periodo de tratamento de 12 semanas. Com base nos achados clinicos e espirometricos, verificou-se broncodilataçao eficaz com melhora clinica apos a inalaçao da droga ao longode todo o periodo de observaçao. De forma detalhada, o comportamento tanto dos valoresdo VEF nos dias de controle como os dados do peak flow expiratorio (PFE)moniorados diariamente pelo proprio paciente mostraram uma elevaçao constante eestatisticamente significante apos o uso do broncodilatador, com efeito imediato, duradouro e persistente durante o periodo de tres meses; as taxas automonitoradas do PFE foram particularmente compativeis com este resultado. Nao se notou efeitos colaterais em nenhum dos casos, inclusive em cinco pacientes que necessitaram de inalaçoes extras.