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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anticholinergics (in particular, ipratropium bromide [Atrovent]) are first-line therapy in patients with chronic obstructive pulmonary disease (COPD). Although more studies are needed to support the use of combination therapy, adding an inhaled beta agonist to the therapeutic regimen is reasonable in patients who remain symptomatic and need quick relief. Patients frequently receive inadequate amounts of drug with standard doses delivered by metered-dose inhalers, often as the result of improper technique, so symptomatic patients may require higher doses. Caution is recommended when the dose of inhaled sympathomimetics is increased in COPD patients with ischemic heart disease or tachyarrhythmias. The addition of an oral sympathomimetic is seldom necessary. Theophylline may be considered in outpatients who remain symptomatic despite their use of inhaled bronchodilators, but heart disease, seizure disorders, and gastroesophageal reflux are contraindications. Corticosteroid therapy remains controversial but can be helpful in patients who still have severe disease despite maximum bronchodilator therapy. Antibiotics can be of benefit in COPD patients undergoing an exacerbation who have increasing dyspnea, cough, and phlegm production.
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PMID:Drug treatment of COPD. Controversies about agents and how to deliver them. 134 54

The epidemiology, etiology and pathophysiology, clinical presentation and diagnosis, and drug therapy of asthma in children are reviewed. Recent advances in drug therapy have, for unknown reasons, been accompanied by an increase in the morbidity and mortality associated with childhood asthma. The cause of asthma is not precisely understood, but an inflammatory process and hyperactivity of airways are common findings in the disease. Asthma in children can be classified as intermittent, chronic, or indeterminate; a severe, prolonged episode not relieved by usual treatment is called status asthmaticus. The hallmark symptoms of asthma are coughing, dyspnea, and wheezing. Beta-adrenergic agonists can be used orally for diagnostic purposes or for nocturnal asthma; i.v. or s.c. for emergency treatment; or by inhalation for relief of acute asthmatic episodes. Experience with anticholinergics in children is limited, and these agents should be used only when other options have failed. Inhalation of cromolyn sodium is very safe and is useful for the prophylactic treatment of mild to moderate asthma. Corticosteroids, which are used both for acute asthmatic episodes and for long-term treatment, can be given orally, i.v., or by inhalation. Theophylline is used for prophylactic therapy in children with chronic asthma. Selection of a drug regimen is based on knowledge of efficacy, pharmacokinetics, compliance, and toxicity. The treatment of asthma in children requires consideration of drug properties in young patients. Drugs used to treat childhood asthma include beta agonists, anticholinergics, cromolyn sodium, corticosteroids, and theophylline.
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PMID:Treatment of asthma in children. 158 29

A total of 104 asthmatic patients with symptoms of asthma and/or a 'morning dip' in the peak expiratory flow rate (PEFR) who were receiving multiple therapies, including inhaled or oral steroids, were treated in addition once nightly with controlled-release theophylline in an 8-week double-blind, placebo-controlled cross-over study. Theophylline produced an improvement in symptoms of cough, wheeze, sleep disturbance and PEFR in the 73 completing patients compared to run-in and placebo treatment. Theophylline also produced an improvement in the forced expiratory volume in 1 s and forced vital capacity relative to baseline, and in the difference between actual and predicted PEFR values. Nausea was the most frequent side-effect but both patients' and investigator's global impressions of the effect of study medication were in favour of theophylline.
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PMID:Controlled-release theophylline in the treatment of nocturnal asthma. 222 74

The airway response to the inhalation of four alkyl xanthines was studied in 17 subjects with moderately severe asthma (mean FEV1 1.19 litres, 42% predicted). Theophylline (10 mg/ml), glycine theophyllinate (50 mg/ml), theophylline ethylenediamine (aminophylline 50 mg/ml), and diprophylline (125 mg/ml) were administered by nebulisation and the airway response was measured as percentage change from baseline of specific airway conductance (sGaw). All xanthine derivatives had an unpleasant taste and produced coughing at the onset of nebulisation. All four xanthines produced a significant increase in sGaw by comparison with saline placebo, with a maximum mean increase from baseline of 35% for theophylline, 40% for glycine theophyllinate, 60% for aminophylline, and 32% for diprophylline. Inhalation of 200 micrograms salbutamol from a metered dose inhaler produced an additional increase in sGaw of 149%. Thus alkyl substituted xanthines administered by inhalation to patients with asthma cause significant short lived bronchodilatation, but this effect is small compared with that of a conventional dose of an inhaled beta 2 adrenoceptor agonist.
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PMID:Bronchodilator actions of xanthine derivatives administered by inhalation in asthma. 398 84

The therapeutic value of adding a slow-release theophylline product (Theo-Dur) to the regular treatment program consisting of beta-stimulants and steroids was evaluated in 31 adult asthmatics. Theophylline in a dose of 300 mg or placebo was administered twice daily during two 14-day periods in a randomized double-blind cross-over study. PEF and asthma symptoms were recorded daily. In the morning, 12 h after tablet intake, spirometry was performed and the theophylline concentration determined. The addition of theophylline slightly, but statistically significantly, increased the daily PEF values and reduced dyspnoea, but not cough, sputum volumes and aerosol consumption. The patients showed preference for the combined treatment. Spirometry at the end of each period did not differ significantly between treatments. The mean theophylline concentration in the morning 12 h after tablet intake was 39 mumol/l (range 15-81 mumol/l). The results of the study suggest that the addition of a slow-release theophylline preparation to beta-stimulant therapy provides further relief of asthma symptoms without an unacceptable increase in the incidence of side-effects.
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PMID:Combined theophylline/beta-agonists maintenance therapy in chronic asthma. 613 32

Theophylline is commonly recommended for patients who have stable chronic airflow obstruction (CAO). Recent evidence confirms that serum theophylline concentrations between 10 and 20 mg/L may increase forced expiratory volume in 1 s (FEV1) and forced vital capacity in these patients. Exercise tolerance, however, and the classic respiratory symptoms of wheezing, breathlessness, cough, and sense of well-being do not improve. A reappraisal of the role of this medication in patients with stable CAO is therefore necessary; we recommend not prescribing this medication for all patients. Instead, the response of FEV1 after isoproterenol inhalation (0.15 mg) should be monitored. This simple test has good efficacy for predicting the response to oral theophylline therapy and could diminish the cost and unnecessary side effects of theophylline while benefiting those who will respond.
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PMID:Theophylline in stable chronic airflow obstruction. A reappraisal. 639 7

Theophylline belongs to a group of medicaments used in asthma therapy. It yields an antiinflammatory effect, reduces allergic reactions, and in respiratory airways it improves the mucociliary clearance and eminently dilates smooth muscles. Therefore, the main aim of our interest is its effect on the cough reflex. Cough was evoked by mechanical irritation of the airways in cats with chronic tracheal cannula. It has been discovered that theophylline, when dosed 10 mg per kg of body weight i.p. achieved a more intensive effect than dextromethorphane, namely in evaluation of cough parameters, but it had a lower suppressive effect than codeine. (Fig. 3, Ref. 13.)
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PMID:[The antitussive effect of theophylline]. 781 40

Preliminary reports suggest that some pharmacologic agents may be effective in ameliorating angiotensin-converting enzyme (ACE) inhibitor-induced cough and, perhaps, allowing continuing use of ACE inhibitors in patients for whom this class of medication is important. We examined the effect of a once-a-day theophylline formulation on ACE inhibitor-induced cough and on the sensitivity of the cough reflex to capsaicin in 10 hypertensive patients who had developed cough during treatment with an ACE inhibitor. Theophylline did not induce bronchodilation but induced complete remission of clinical symptoms in 8 and attenuated the capsaicin-induced cough number in 7 subjects when compared with placebo. Theophylline may thus be effective in preventing ACE inhibitor-induced cough.
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PMID:Theophylline in the inhibition of angiotensin-converting enzyme inhibitor-induced cough. 826 77

Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of diseases characterized by cough, sputum production, dyspnoea, airflow limitation and bronchial hyperreactivity. The airflow limitation declines progressively and is irreversible or partially reversible. Bronchodilator therapy is prescribed to relieve the symptoms, reverse airway obstruction and hopefully slow the rate of disease progression and decelerate the decline in pulmonary function. During acute exacerbation, inhalation of beta2-agonists remain the therapy of choice. The usefulness of anticholinergic inhalation in acute attacks is investigated in order to determine if a higher dose and more frequent administration have same benefit as beta2-agonists inhalation. Theophylline is usually given orally as a sustained release formulation for chronic maintenance therapy. Some patients may benefit from theophylline infusion during an acute phase when appropriately used; however, sympathomimetic agents fail to produce adequate bronchodilation. During interim periods of stability, inhalation of ipratropium bromide has increased in popularity as a regular long-term bronchodilator therapy. Although ipratropium and beta2-agonists are equally efficacious when the dosage is adequate enough, a combination of both provides a rapid onset of action of the adrenergic agents and a prolonged action of the anticholinergic. Furthermore, this combination can be given in a reduced dose, thereby avoiding side-effects. Inhalation techniques can influence the efficacy of bronchodilator therapy. For severe dyspnoeic patients or patients with poor technique of co-ordination with metered-dose inhaler (MDI), attachment of a spacer to the MDI or using a nebulizer will overcome these difficulties. Bronchodilator therapy can not prevent the development of COPD or slow down the decline of pulmonary function, other interventions should be included in a comprehensive management programme.
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PMID:Bronchodilator therapy for chronic obstructive pulmonary disease. 952 4

Theophylline toxicity has been recognized since its introduction into clinical medicine. Clarithromycin is a new oral macrolide antibiotic with excellent antibacterial activity and rare adverse effect. Patients with upper respiratory infection are often treated with theophylline and clarithromycin concurrently. We report a case of acute renal failure due to acute rhabdomyolysis caused by the interaction of theophylline and clarithromycin. A 72-year-old man visited our hospital because of coughing and a sore throat continuing for 1 week. He was diagnosed as having the common cold with a bronchial asthmatic symptom and was prescribed 200 mg/day of sustained-release theophylline for the treatment of asthma for 7 days. One week later, he visited our hospital again. Radiographic study of the chest revealed mild interstitial pneumonia and 200 mg/day of sustained-release theophylline and 400 mg/day of clarithromycin were administrated concomitantly. Five days after the second visit, the patient was admitted to our hospital because of generalized twitching, muscular weakness, high fever and serious general condition. He experienced generalized muscular twitching and tremor. Blood urea nitrogen was 106.1 mg/dl, serum creatinine was 7.4 mg/dl, serum creatinine kinase (CK) was 36,000 IU/l (normal 15-130 IU/l), CK isozyme revealed the following ratio: BB 0%, MB 1% and MM 99%. He was diagnosed as having acute renal failure with rhabdomyolysis caused by the interaction of theophylline and clarithromycin. Hemodialysis therapy was started. After 5 weeks, his serum creatinine was markedly decreased. It is well-known that clarithromycin enhances the serum concentration of theophylline by inhibition of the cytochrome P450-dependent pathway in hepatocytes. Theophylline toxicity may be enhanced when clarithromycin is administrated concomitantly, especially to elderly patients with dehydration.
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PMID:[A case of acute renal failure with rhabdomyolysis caused by the interaction of theophylline and clarithromycin]. 1044 97


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