O2.1 Methylxanthines

Theophylline is rarely used for COPD in Australia.  A small randomised placebo controlled trial in China demonstrated that doses of 100mg twice daily reduced exacerbations compared with placebo (Zhou 2006).  In this study, patients were not on inhaled corticosteroids or long-acting bronchodilators which limits the generalisability of the study findings.  Devereux et al randomised 1,567 UK-based COPD patients with a history of exacerbations to theophylline or placebo.  All patients were receiving inhaled corticosteroids and 80% of patients were on ‘triple-therapy’ (Devereux 2018). Patients were permitted to continue with their usual COPD medications.  There was no difference in exacerbation rates at 12 months.  Based on the available evidence, theophylline cannot be recommended in COPD in the Australasian context [evidence level II].