Theophyllin in der Langzeittherapie der COPD - immer noch aktuell?

Zusammenfassung

Die COPD ist im letzten Jahrzehnt in den Mittelpunkt des Interesses der Pneumologen und der klinisch-therapeutischen Forschung gerückt. Erkenntnisse über die weltweit ansteigende Morbidität und Letalität und deren sozio-ökonomische Folgen haben die Aufgabe, sich mit dieser Erkrankung zu beschäftigen, dringlicher gemacht. Neue Therapieoptionen berechtigen zu einem vorsichtigen Optimismus. Das Repertoire der Pharmakotherapie wurde um die Indikation für lang wirksame Betaadrenergika und das lang wirksame Anicholinergikum Tiotropium bereichert, inhalative Glukokortikoide gewinnen nun auch bei der COPD an Reputation. Über diesem neuen Trend scheint eine altbewährte und kostengünstige Substanz, das Theophyllin, in den Hintergrund zu geraten. Diese Übersichtsarbeit verweist auf seine gut dokumentierte Wirkung als Bronchodilatator und auf additive Effekte in Kombination mit Betaadrenergika und Anticholinergika. Weitere positive Wirkungen des Theophyllins auf Dyspnoe und Belastbarkeit, auf die Atemmuskulatur und auf Herz-Kreislauf-Funktionen werden diskutiert, jedoch besteht zur Klärung der klinischen Relevanz noch Forschungsbedarf. Bei kritischer Verordnung und Überprüfung der individuellen Reaktion bleibt Theophyllin für einen Teil der Patienten mit COPD eine wertvolle therapeutische Option.

Abstract

In the last decade the interest of pneumologists and therapeutic research has been focused on COPD. The increasing morbidity and mortality world wide and the important socio-economic impact challenged to improve the therapeutic options. New indications like LABA and newly introduced drugs like tiotropium may help to ameliorate symptoms, ICS potentially help to protect against exacerbations and to suppress components of the inflammatory process even in COPD. A reappraisal of the place of theophylline in the stepwise approach to treat these patients seems to be useful. This report reviews its effects as bronchodilator and the well documented additive effects in combination with betaadrenergics and anticholinergics. Further desirable actions of theophylline on the sensation of dyspnoea and on exercise capacity, on respiratory muscle function and on the cardiovascular performance are discussed but no definite conclusions can be made about the clinical utility of these effects. Given that patients are carefully selected in terms of benefit and side effects theophylline may remain a valuable therapeutic option.

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