11:1229825. doi: 10.3389/fchem.2023.1229825. For example, among users of theophyllines in monotherapy the rate of filled prescriptions of oral corticosteroids was 72 per 100 patient-years (4432 filled prescriptions divided by 6156 patient-years) and was lower than the rate among users of theophyllines plus ICS, which was of 118 filled prescriptions of oral corticosteroids per 100 patient-years. keep within therapeutic range (5 to 15 Long-term control of reversible airway obstruction caused by asthma or COPD. A previous validation study has shown that the RAMQ databases were accurate in distinguishing COPD from asthma [25]. Distribution: Widely distributed; crosses the placenta and into breast milk; does not distribute into adipose tissue. Treatment episodes with theophyllines plus LABA were excluded from the comparison because of the small number of patients under this treatment regimen. Moreover, DFT-based quantum chemical descriptors revealed strong interactions between the polymeric host and the quetiapine drug. Accessibility government site. Background Intravenous theophyllines are a second line treatment for children suffering an acute exacerbation of asthma. - given orally or intravenously. and transmitted securely. Ziment I. Theophylline and mucociliary clearance. Poisson regression models were also performed to estimate the adjusted rate ratios of moderate to severe COPD exacerbations comparing patients who had regimens with same number of adjuvant therapies: (i) theophyllines vs. ICS; (ii) theophyllines vs. LABA; and (iii) theophyllines plus ICS vs. LABA plus ICS. prescribed. Lastly, theophylline is associated with adverse gastrointestinal effects as well as serious cardiovascular (tachycardia and arrhythmias) and central nervous system side-effects attributed to nonselective inhibition of PDE, even at therapeutic doses [31]. Erectile dysfunction (ED) is often a symptom . More severe reactions can occur with higher therapeutic Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Artemisinin, which is derived from the sweet wormwood plant and is used to treat malaria, is another natural product that contains six-membered heterocycles. In the ISOLDE trial, the annual rate of exacerbations among moderate to severe COPD patients was 1.90 (SD 2.63) for placebo group and 1.43 (SD 1.93) for patients on ICS after 3 years of treatment [7]. A prospective study of 200 patients. On the other hand, the dose of ICS (1000 vs. >1000 g per day in beclomethasone equivalent) was not found to be significantly associated with the risk of exacerbations when ICS were given in monotherapy (adjusted RR 0.99, 95% CI 0.96, 1.0) but was when ICS were given in addition to theophyllines (adjusted RR 1.04, 95% CI 1.01, 1.07). However, in this model, users of theophyllines were found to be significantly (11%) less likely to have moderate to severe COPD exacerbations than users of LABA (adjusted RR 0.89, 95% CI 0.84, 0.95). Burden of disease implications for future research. The Table 2 shows the characteristics of all study patients according to compared treatment regimens. doubled. The .gov means its official. Methods: PMC Effectiveness of medication review: a systematic review and meta-analysis of randomized controlled trials BMC Fam Pract. . Theolair is a prescription medicine used to treat the symptoms of Acute Bronchospasm. However, in the United States, asthma and COPD are mainly treated with other agents, and theophylline is largely used to treat bradycardia and apnea in premature newborns. Bethesda, MD 20894, Web Policies medication as prescribed. Use cautiously in clients who have heart disease, hypertension, Patients were also censored if they left the RAMQ drug plan insurance, received one asthma diagnosis, were hospitalized for >30 days or started a continuous therapy of oral corticosteroids, because these events would preclude the evaluation of our main outcome. theophyllines (aminophylline, theophylline or oxtriphylline in oral formulation); ICS (beclomethasone, triamcinolone, flunisolide, budesonide or fluticasone); LABA (salmeterol or formoterol); theophyllines and ICS concurrently; ICS and LABA concurrently; and theophyllines, ICS and LABA concurrently. Results: Activated charcoal is used to, decrease absorption, lidocaine is used to, treat dysrhthmias, and diazepam is used to, Depending on therapeutic intent, effectiveness is. O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk D, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Maltais F, Road J. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease 2003. However, RCTs have shown that patients treated with LABA [33, 34] or LABA plus ICS [35] have a significant greater improvement in lung function [forced expiratory volume in 1 s (FEV1), forced vital capacity and morning peak expiratory flow], a higher percentage of symptom-free (cough, wheezing and shortness of breath) days and use less rescue medications (salbutamol or albuterol) than patients treated with theophyllines [33, 34, 36] or theophyllines plus ICS [35]. doi: 10.1002/14651858.CD001240.pub3. Poisson regression models were performed to investigate the effect of the daily dose of theophyllines and ICS on the rate of exacerbations. Alshammari et al. A cohort of 36 492 chronic obstructive pulmonary disease (COPD) patients aged 50 years was reconstructed from the health administrative databases of the province of Quebec, Canada, between 1 January 1995 and 31 December 2002 to compare users of theophyllines with users of inhaled corticosteroids (ICS) and users of long-acting 2-agonists (LABA) on their rate of moderate to severe COPD exacerbations. This effect may account in part for their efficacy [31]. GI: nausea, vomiting, anorexia. From the RAMQ databases a large cohort of COPD patients aged 50 years between 1 January 1995 and 31 December 1999 was selected. Third, the exposure to treatment was based on dispensed prescriptions, which might not correspond exactly to the intake of the medications. Catherine Lemiere has also received consulting fees and speaker fees from AstraZeneca, GlaxoSmithKline, Altana Pharma, Merck Frosst and Novartis. Imatinib: a medicine for the treatment of chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). Ezzatzadeh et al. FOIA Depending on therapeutic intent, effectiveness is How should this medicine be used? Van Andel AE, Reisner C, Menjoge SS, Witek TJ. However, the introduction of newer pharmacologic agents, concern about the toxicity of. conducted a collaborative study involving researchers from various countries, including Egypt, Germany, the United States, and Saudi Arabia. PMC pharmacokinetics. 2018 Oct;177(10):1425-1434. doi: 10.1007/s00431-018-3221-z. Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and Google Scholar databases were systematically searched. Unauthorized use of these marks is strictly prohibited. Theophylline in asthma and COPD: changing perspectives and controversies. No other significant difference was found for the other treatment comparisons. Follow-up was stopped either when patients reached the end of the study period, i.e. is the recipient of a salary award form the Fonds de la recherche en sant du Qubec (FRSQ). Table 4 displays the crude rate of moderate to severe COPD exacerbations; this rate was found to be higher among patients with two adjuvant therapies (users of theophyllines plus ICS or users of LABA plus ICS) than patients with only one adjuvant therapy. Activated charcoal is Tavakol and Firouzi reported on the synthesis of 14H-dibenzoxanthenes using Sn(II)/nano silica as an efficient catalyst in green media. Advise patient to minimize intake of caffeine or other xanthine-containing foods or beverages (colas, coffee, tea, chocolate) and to reduce intake of charcoal-broiled foods. Evaluation of Medication Effectiveness. PMID: 3667006 Abstract In this study the effectiveness and safety of a new controlled-release theophylline formulation were evaluated. An isolated medication review during a short term intervention period has an effect on most drug-related outcomes, minimal effect on clinical outcomes and no effect on quality of life. Fetal tachycardia has been observed when maternal blood concentration exceeds 20 g/ml (27). To evaluate the effects of prophylactic theophylline in renal function and survival rates of asphyxiated newborns. Cascorbi, I. Khanlari et al. Among study patients, we observed that 22.9% had at least one treatment episode with theophyllines during the study follow-up and 63.7% had at least one treatment episode with ICS. COPD, Chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; LABA, long-acting 2-agonists; SABA, short-acting 2-agonists. found a significant reduction of 25% in the rate of exacerbations comparing users of fluticasone propionate (ICS) with placebo (P = 0.026) among patients with moderate to severe COPD. Di Lorenzo G, Morici G, Drago A, Pellitteri ME, Mansueto P, Melluso M, Norrito F, Squassante L, Fasolo A. Efficacy, tolerability, and effects on quality of life of inhaled salmeterol and oral theophylline in patients with mild-to-moderate chronic obstructive pulmonary disease. Before Please click Continue to continue the affiliation switch, otherwise click Cancel to cancel signing in. GI: nausea, vomiting, anorexia. The site is secure. Dtsch. From this Poisson regression model it was also observed that women were significantly less likely than men to have an exacerbation, that for every increase of one unit in the score of comorbidity the risk of exacerbations increased by 5% (crude RR 1.05; 95% CI 1.046,1.050), but this association was not found to be statistically significant when we adjusted for other covariables (adjusted RR 1.001; 95% CI 0.999, 1.003), whereas patients with markers of disease severity were more likely to have an exacerbation. 1989;83(22):1097-102. From three-to six-membered heterocycles bearing a quaternary stereocenter: An asymmetric organocatalytic approach. Medication Administration. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes. Neuro: tremor. Theophylline Methylxanthines. All randomized controlled trials evaluating the efficacy of theophylline in the prevention of perinatal asphyxia were selected. Theophylline is used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases. Careers. dose is missed, the following dose within therapeutic range (5 to 15 mcg/mL). This study has several strengths, namely a large sample size, a cohort representative of the population of COPD patients, a long follow-up of up to 7 years and details about pharmacological treatments taken during all these years. The use of theophyllines is associated with a reduction in the rate of COPD exacerbations compared with long-acting , Theophyllines could be seen as an interesting alternative in the treatment of COPD, because they are much less expensive than long-acting , administrative database, cohort study, COPD, exacerbations, theophylline. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). HHS Vulnerability Disclosure, Help Pilote L, Lavoie F, Ho V, Eisenberg MJ. FOIA Nevertheless, theophylline remains an important drug: It is still used within the United States to treat apnea and . Assess pulmonary function periodically by measuring lung volumes, breath sounds, respiratory rate, and other symptoms (wheezing, dyspnea, shortness of breath) (See Appendixes I, J, K). Received: 27 May 2023; Accepted: 31 May 2023;Published: 08 June 2023. ED is often a symptom of another health problem or health-related factor. 23, e202300066. The main outcome was the rate of moderate to severe COPD exacerbations, i.e. Evaluation of Medication Effectiveness. Cross), Relaxation of bronchial smooth muscle, resulting in It relaxes and opens air passages in the lungs, making it easier to breathe. Adverse Reactions/Side Effects CNS: SEIZURES, anxiety, headache, insomnia, irritability. This study used claims data from the health administrative database of the Rgie de l'Assurance Maladie du Quebec (RAMQ) and data from the MED-ECHO database from the Canadian province of Quebec. (2023). Future large-scale trials should assess potential long-term adverse outcomes in clinical practice.KeynotesAsphyxia is a major cause of acute kidney injury in neonatesAcute kidney injury is associated with adverse clinical outcomes in asphyxiated neonates.Theophylline administration leads to significantly lower incidence of acute kidney injury in asphyxiated neonates. evidenced by long-term control of asthma and COPD. Received 2006 Oct 25; Accepted 2007 May 6. 164 Citing Articles Theophylline has been a popular medication for asthma for over 50 years. medication. Mild toxicity reaction can include GI distress and These medications should be Do not chew or crush The RAMQ database also contains patients' socio-demographic data, such as age, gender and date of death, as well as a variable indicating whether a patient is receiving social assistance or a supplement added to the Old Age Security pension. Once the first line medication for asthma, now used infrequently because newer medications are safer and more effective. pdf, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1, Psychology (David G. Myers; C. Nathan DeWall), Give Me Liberty! and transmitted securely. View Theophylline.pdf from NUR MISC at D'Youville College. Several clinical trials have shown that theophyllines improve lung function and dyspnoea [10, 11] in patients with COPD. Second, the diagnosis for hospitalizations and emergency visits were based on the diagnoses recorded in the RAMQ and MED-ECHO databases, and were not validated with the medical chart. Patients using theophyllines alone or in addition to ICS had a slightly higher score of continuity of care than other patients. Davis's Drug Guide for Rehabilitation Professionals, https://fadavispt.mhmedical.com/content.aspx?bookid=1873§ionid=139027751. Before National Library of Medicine Allegaert K, Smits A, van Donge T, van den Anker J, Sarafidis K, Levtchenko E, Mekahli D. Front Pediatr. Users of theophyllines were found to be more likely than users of ICS to have a COPD exacerbation (crude rates 84 vs. 77 per 100 patient-years, adjusted RR 1.07, 95% CI 1.04, 1.10), and this association was even stronger among patients who had at least three exacerbations in the year prior to cohort entry (crude rates 273 vs. 213 per 100 patient-years, adjusted RR 1.28, 95% CI 1.19, 1.38). . eCollection 2020. In conclusion, theophyllines could be seen as an effective therapy in selected COPD patients who tolerate this medication well. - direct effect on the smooth muscles of the respiratory tract, both those . During the 30 days of controlled-release theophylline therapy, all patients reported a marked clinical improvement, confirmed by spirometric data (ventilation indexes, intrapulmonary air distribution, ventilation control, gas exchanges). Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial. The baseline characteristics of the study patients are summarized in Table 1. The crude rate of moderate to severe COPD exacerbations was estimated for all treatment regimens. 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For all the other regimens, there was at least one medication added to the SABA and/or ipratropium bromide and one to three adjuvant therapies, i.e. A total of 37.9% of patients received at least one prescription of oral corticosteroids, 29.0% had at least one visit to an ED for COPD and 19.2% were hospitalized for COPD in the year prior to cohort entry. from India published a review article in our Research Topic focusing on recent advances and prospects in the organocatalytic synthesis of quinazolinones. In this study, we observed that 86% of theophylline users renewed their prescription at least once during follow-up. M-C.C. This is of practical importance, since 1.3% of pregnant women have asthma. Clipboard, Search History, and several other advanced features are temporarily unavailable. Monitor theophylline serum levels to Regorafenib: a treatment for certain types of cancer, including colorectal cancer and gastrointestinal stromal tumors (GIST) that no longer respond to other treatments. Around the world, theophylline (1,3-dimethylxanthine) is primarily used as a bronchodilator for patients with asthma and chronic obstructive pulmonary disease (COPD). Moreover, theophylline users filled 11 prescriptions per year, on average, suggesting that they tolerated their medication well and that our cohort might be over-represented by patients who tolerate theophyllines well. Moreover, theophyllines may increase responsiveness to ICS, avoid steroid resistance and allow ICS to suppress chronic inflammation in COPD patients [32]. Data on medical and pharmacy services were obtained 1 year before cohort entry and during study follow-up. An example of the assessment of exposure for a patient during the entire follow-up is presented in Figure 1. Front Pediatr. A patent review on efficient strategies for the total synthesis of pazopanib, regorafenib and lenvatinib as novel anti-angiogenesis receptor tyrosine kinase inhibitors for cancer therapy. COPD patients had, on average, a high comorbidity score of 8.9 (SD 4.1). In this RCT, the mean percentage of patients receiving additional therapy for COPD exacerbations (corticosteroids, antibiotics or oxygen) during follow-up was lower among patients receiving theophyllines (20%) than among those receiving 12 g of inhaled formoterol (32%) or 24 g of inhaled formoterol (23%). Please consult the latest official manual style if you have any questions regarding the format accuracy. This combined experimental and theoretical investigation showed promising results, with the synthesized compounds exhibiting high antioxidant and antimicrobial abilities. Only a single exacerbation was considered if more than one marker of exacerbation [prescription of oral corticosteroids, Emergency Department (ED) visits for COPD or hospitalizations for COPD] occurred within a period of 15 days. Users of theophyllines were found to be less likely than users of LABA [crude rates 84 vs. 91 per 100 patient-years, adjusted rate ratio (RR) 0.89, 95% confidence interval (CI) 0.84, 0.95] and users of theophyllines plus ICS were found to be less likely than users of LABA plus ICS (crude rates 114 vs. 112 per 100 patient-years, adjusted RR 0.89, 95% CI 0.87, 0.92) to have moderate to severe COPD exacerbations. theophylline levels. Monitor theophylline blood levels to keep. Because of its restricted therapeutic range and high inter-individual PK variability, therapeutic. Cross). Theophyllines, as the only adjuvant therapy or in addition to ICS, were found to be more effective than LABA in avoiding moderate to severe exacerbations. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. Acute exacerbations are the most frequent cause of hospital admissions and death among COPD patients [4]. medication. Effects of methylxanthines on airway mucociliary function. All comparisons were performed twice, once among all COPD patients and secondly among patients who had three exacerbations of COPD or more in the year prior to cohort entry. diazepam is used to control seizures. The synthesis and bioapplication of six-membered heterocycles from natural products has become an active research field. Vignola AM. sustained-release preparations. It also avoids recall bias by the use of administrative database. Dorais M, Blais L, Chabot I, LeLorier J. 2019 Jul;104(7):670-679. doi: 10.1136/archdischild-2018-315805. Although the goals of COPD management include the prevention of disease progression and the reduction of mortality, they also include symptom relief, treatment and prevention of exacerbations and the improvement of health status [5]. levels less than 20 mcg/mL. Mild toxicity reaction can include GI distress and, More severe reactions can occur with higher therapeutic. doi:10.1002/tcr.202300066, PubMed Abstract | CrossRef Full Text | Google Scholar, Shiri, P., Ramezanpour, S., Amani, A. M., and Dehaen, W. (2022). pharmacodynamics. The site is secure. PHYSICAL THERAPY IMPLICATIONS Examination and Evaluation Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Authors evaluated the appropriateness of the fol-lowing procedures: indications for theophylline serum concentration measurement, timing of blood sampling and dosage adjustments made after. Miao Y, Zhou Y, Zhao S, Liu W, Wang A, Zhang Y, Li Y, Jiang H. PLoS One. Please enable it to take advantage of the complete set of features! bronchodilation. effective. Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Relaxation of bronchial smooth muscle, resulting in, Once the first line medication for asthma, now used, infrequently because newer medications are safer and more, Caffeine, Phenobarbital, phenytoin, and rifampin decrease, Cimetidine, ciprofloxacin, and other fluoroquinolone. EPIDEMIOLOGY. Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. used to decrease absorption, lidocaine To determine the effectiveness of theophyllines in real clinical practice on moderate to severe exacerbations. An episode was defined by the number of consecutive days a patient remained under the same treatment regimen. 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