ABSTRACT
Objective: to assess the efficacy of adding Slow-Release Theophylline to the regular treatment of Chronic Obstructive Pulmonary Disease [COPD] patients. The safety of Theophylline was also assessed as a secondary endpoint
Methods: prospective observational study of one hundred and nine patients, with moderate to very severe COPD, and treated in the pulmonology clinic at King Hussein Medical Center, between August 2014 and March 2015. Exclusion criteria included: acute exacerbation of COPD within the last 3 months; use of oral corticosteroids within the last 4 weeks; upper or lower respiratory tract infection within the last 4 weeks; recent unstable angina or arrhythmias; epilepsy; concurrent use of medications that might interact with Theophylline and excessive alcohol consumption. After enrolment, Forced Expiratory Volume in the first second [FEV 1] and Forced Vital Capacity [FVC], oxygenation at rest using 2 different pulse oximeters and level of disability assessed by the Medical Research Council dyspnoea scale were evaluated. A fixed dose of oral Theophylline was added to their regular treatment, as Theophylline [Quibron-T SR] 300 mg slow-release capsules once daily. The patients were followed up after 4 weeks, when the measurements were repeated. The patients were also evaluated for any side effects related to Theophylline. The pre and post-Theophylline data were compared. The safety profile of Theophylline was assessed by recording side effects related to the drug, any serious side effects, or Theophylline withdrawal
Results: out of the 109 patients in our study, 96[88%] were males, and 13[12%] were females. Their mean [ +/- SD] age was 69.0 +/- 7.8 years [range 46-83 years]. After 4 weeks of added Theophylline, there was a statistically significant improvement in FEVl from 53 .3 +/- 10.4 to 56.4 +/- 10.1 [% predicted mean +/- SD] [p= 0.03] and FVC from 70.4 +/- 10.0 to 73.1 +/- 9.8% [p= 0.05]. 61 % of the patients showed improvement in dyspnoea, with a significant improvement in the MRC score from 3.8 +/- 0.8 to 3.2 +/- 0.8 [p<0.0001]. The patients also showed an increase in saturation from 93.6% +/- 2.3 to 93.8% +/- 2.0, though this was not statistically significant [p= 0.490]. 5 patients [5%] had side effects related to Theophylline,though none were serious. The most common side effect was nausea [60%]. None of the patients who developed side effects stopped using Theophylline during the study
Conclusion: theophylline produced a significant increase in the lung function of patients with moderate, severe and very severe COPD and significantly improved their disability caused by dyspnoea, without any serious side effects. Use of Theophylline in stable COPD patients should be weighed however against the risk of possible non-serious side effects, mainly nausea
ABSTRACT
In recent years, Flexible Fiberoptic Bronchoscopy [FFB] has been applied for diagnostic and some therapeutic purposes. During FFB and even in the presence of supplemental oxygen, hypoventilation leading to hypoxia and desaturation may occur; this is aggravated by the use of suction. Arterial oxygen saturation is usually monitored with pulse oximetry [Spo2] during FFB; End-Tidal Pco2 [ET-Pco2] monitoring is not routinely used. Two-hundred patients were studied between May 1998 till April 2003, at the divisions of chest surgery and Pulmonology at King Hussein Medical Center, [KHMC]. Their ages 53 +/- 19 years [mean +/- SD], underwent FFB and received supplemental oxygen during various stages of FFB: 1-before and during installation of lidocaine on the vocal cords, 2-during passage of instrument into the trachea, RMB, IMB, 3-during bronchoalveolar lavage, bronchial biopsy, Trans Bronchial Biopsy [TBB], and 4-at the final stages of FFB. ET-Pco2 changes were studied with a capnograph and Spo2 using a pulse oximeter simultaneously and the results were recorded. Mean ET-Pco2 significantly decreased from 28.7 +/- 4.5 mmHg before FFB to 28 +/- 5.7 mmHg, 27.9 +/- 5.5 mmHg, 27.5 +/- 5.6 mmHg, 27.1 +/- 4.5 mmHg, 27.9 +/- 5.3 mmHg during bronchoscopy of the Right Main Bronchus [RMB], Left Main Bronchus [LMB], bronchial washing, bronchial biopsy and Trans Bronchial Biopsy [TBB], and at the termination of FFB, respectively [p<0.05]. In 118 patients [59%], the decrease of ET-Pco2 was equal to or greater than 4 mmHg; in 105 patients [52.5%] the amount of decrease in Spo2 was = 5% and in 32 patients [16%], Spo2 decreased = 10%. No correlation was found between decreasing ET-Pco2 and Spo2 during the procedure. ET-Pco2 and Spo2 decreased during bronchoscopy. We also speculate that this reflects airway obstruction by the instrument. Further studies and more experimental analysis in this field is recommended