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Methylxanthines
Theophylline, the methylxanthine principally used in treating
asthma, provides mild-to-moderate bronchodilation. Monitoring
serum theophylline concentrations is essential to ensure that
therapeutic, but not toxic, doses are achieved.
Recent evidence suggests that low serum concentrations of
theophylline are mildly anti-inflammatory.
Sustained-release theophylline is mainly used as adjuvant
therapy, and is particularly useful for controlling symptoms
of nocturnal asthma.
When there are issues concerning cost or adherence to regimens
using inhaled medication, sustained-release theophylline can
be considered as an alternative long-term preventive therapy,
but is not preferred.
Note:
Patients on chronic theophylline should have a serum
theophylline determination at least once each year to decrease
the risk of theophylline toxicity.
Elderly asthmatics should also be monitored closely as
they may be suffering from other illness like heart disease.
Leukotriene Modifiers
Leukotriene modifiers can be considered an alternative
therapy to low doses of inhaled steroids or cromolyn or
nedocromil for patients 12 years of age (childhood
asthma) or older with mild
persistent asthma.
According to the 1998 Leukotriene Working Group, leukotriene
pathway modifiers may be useful as first-line therapy for mild
persistent asthma or as an add-on or glucocorticoid-sparing
medication in others. These agents are less effective than
glucocorticoid inhalers but tend to improve compliance because
of once-a-day oral dosing.
Anticholinergics
Ipratropiium bromide may be an alternative bronchodilator for
some patients who do not tolerate inhaled beta2-agonists. It
may also provide some additive benefit to inhaled
beta2-agonists during severe exacerbations
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