Is Low-Dose Theophylline Helpful in COPD Patients?

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) currently recommends theophylline only in patients with chronic obstructive pulmonary disease (COPD) for whom other long-term bronchodilators are unavailable or unaffordable (NEJM JW Gen Med Jun 15 2017 and Am J Respir Crit Care Med 2017; 195:557). High-dose theophylline (i.e., plasma concentration, 10–20 mg/L) does have a modest bronchodilator effect at the expense of substantial side effects, but whether lower doses are effective is unclear.

In a U.K. study, 1567 patients with moderate-to-severe COPD and recurrent exacerbations were randomized to low-dose theophylline (200–400 mg daily; target plasma concentration, 1–5 mg/L) or placebo for 1 year. All patients used inhaled c…