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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