Hemlock or Healer? The Mercurial Reputation of Theophylline
Authors: Paul E. Epstein
Journal: Annals of Internal Medicine (1993)

Editorials15 December 1993Hemlock or Healer? The Mercurial Reputation of TheophyllinePaul E. Epstein, MDPaul E. Epstein, MDGraduate Hospital, Philadelphia, PA 19146.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-12-199312150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue of Annals, two articles [1, 2] discuss facets of theophylline administration that recall a hoary clinical dilemma: Is the drug useful enough to justify the danger of serious toxicity and, if so, how should it be used?In the first article, Huang and coworkers [1] describe a carefully performed double-blind, placebo-controlled study that shows convincingly that during the first 48 hours after hospitalization for asthma, theophylline, when added to albuterol and methylprednisolone, produces more rapid and sustained improvement in airflow rates than the same regimen lacking theophylline.In the second, Shannon [2] describes theophylline overdose in 249 ...References1. Huang D, O'Brien RG, Harman E, Reents S, Visser J, Shieh G, et al. Does aminophylline benefit adults admitted to the hospital with an acute exacerbation of asthma? Ann Intern Med. 1993; 119:1155-60. Google Scholar2. Shannon M. Predictors of major toxicity after theophylline overdose. Ann Intern Med. 1993; 119:1161-7. Google Scholar3. Siegel D, Sheppard D, Gelb A, Weinberg PF. Aminophylline increases the toxicity but not the efficacy of an inhaled -adrenergic agonist in the treatment of acute exacerbations of asthma. Am Rev Respir Dis. 1985; 132:283-6. Google Scholar4. O'Byrne PM, Dolovich J, Hargreave FE. Late asthmatic responses. Am Rev Respir Dis. 1987; 136:740-51. Google Scholar5. Town GI, Holgate ST. The role of inflammation in airways disease. In: Mediators of Pulmonary Inflammation. Bray MA, Anderson WH, eds. New York: Marcel Dekker Inc.; 1991:35-79. Google Scholar6. Laitinen LA, Laitinen A. Pathology of human asthma. In: Asthma: Its Pathology and Treatment. Kaliner MA, Barnes PJ, Persson CG, eds. New York: Marcel Dekker, Inc.; 1991:103-34. Google Scholar7. Ward AJ, McKenniff M, Evans JM, Page CP, Costello JF. Theophylline: an immunomodulatory role in asthma? Am Rev Respir Dis. 1993; 147:518-23. Google Scholar8. Milgrom H, Bender B. Current issues in the use of theophylline. Am Rev Respir Dis. 1993; 147:S33-9. Google Scholar9. Bousquet J, Chanez P, Lacoste JY, Barnoen G, Ghavanian N, Enander I, et al. Eosinophilic inflammation in asthma. N Engl J Med. 1990; 323:1033-9. Google Scholar10. Walker C, Kaegi MK, Braun P, Blaser K. Activated T cells and eosinophilia in bronchoalveolar lavages from subjects with asthma correlated with disease severity. J Allergy Clin Immunol. 1991; 88: 935-42. Google Scholar11. Martin RJ. Nocturnal asthma: circadian rhythms and therapeutic interventions. Am Rev Respir Dis. 1993; 147:S25-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: Graduate Hospital, Philadelphia, PA 19146.Corresponding Author: Paul E. Epstein, MD, Pulmonary Division, Graduate Hospital, 607 Pepper Pavilion, 18th and Lombard Streets, Philadelphia, PA 19146. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDoes Aminophylline Benefit Adults Admitted to the Hospital for an Acute Exacerbation of Asthma? David Huang , Ralph G. O'Brien , Eloise Harman , Larry Aull , Stan Reents , Jean Visser , Gwowen Shieh , and Leslie Hendeles Predictors of Major Toxicity after Theophylline Overdose Michael Shannon Metrics Cited ByTheophylline and CaffeineTheophylline: Its rise, demise, and resurrection 15 December 1993Volume 119, Issue 12Page: 1216-1217KeywordsAsthmaBronchodilatorsCellsDrug administrationDrugsEosinophilsInflammationMacrophagesMast cellsToxicity Issue Published: 15 December 1993 CopyrightCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...