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Theophylline and leukotriene modifiers: Is there any compelling role in COPD?

1 Department of Pulmonary and Critical Care Medicine, Medeor JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India
2 Department of Pulmonary Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
3 Department of General Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Correspondence Address:
Rajendra Prasad,
Era's Lucknow Medical College and Hospital, Lucknow - 226 003, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijrc.ijrc_65_19

Chronic obstructive pulmonary disease (COPD) is considered to be an emerging global public health problem. Inhaled therapies are first-line maintenance treatment for COPD, whereas oral drug therapies are used as second or third line maintenance treatment. Oral drugs have modest bronchodilatory as well as anti-inflammatory activities but have lower potency as compared to inhaled therapies. Oral drug therapy can play an important role with several advantages that include distinctive pharmacologic mechanisms of action, prompt availability, ease of administration without the challenges of proper inhalational drug deposition in airways of lung and cost-effectiveness. Theophyllines and leukotriene modifiers are frequently prescribed oral drug therapies worldwide. Although evidence remains weak regarding the exact role of theophyllines in COPD, they are still used alone or as an add-on agent to inhaled therapies but at the expense of narrow therapeutic index leading to dose-dependent toxicities. Leukotriene modifiers are currently prescribed as add-on agents to inhaled therapies in moderate-to-severe asthma. However, the role of leukotriene modifiers in COPD is not very convincing with limited evidence. Overall, there is not any compelling evidence on the utility of theophyllines and leukotriene modifiers in the management of COPD.

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