Oral theophylline as a preventer and oral salbutamol as a reliever in childhood asthma: An option when resources are scarce
Main Article Content
Subhashchandra Daga
http://orcid.org/0000-0001-5840-3804
http://orcid.org/0000-0001-5840-3804
Abstract
Asthma treatment remains challenging, especially in low-resource settings, as it revolves around inhaler devices. The inhalers are too expensive to buy from a pharmacy and not available from a public health facility. Besides, one-to-one training is required for the correct use of inhalers. Therefore, this therapy is associated with low adherence. Improper training leads to faulty use, inadequate treatment, and drug wastage. Asthma is an inflammatory condition that requires a bronchodilator for relief during acute exacerbation and an anti-inflammatory agent for prevention. The use of oral salbutamol, in place of inhaled beta-agonists, and oral slow-release theophylline in place of inhaled corticosteroids offers a feasible option. This may make the treatment easier to deliver and more affordable in low-resource settings.
Keywords:
Oral salbutamol, Low-resource settings, Asthma management, Affordable asthma treatment, Inhaler alternatives, Asthma prevention and relief
Article Details
How to Cite
DAGA, Subhashchandra.
Oral theophylline as a preventer and oral salbutamol as a reliever in childhood asthma: An option when resources are scarce.
Medical Research Archives, [S.l.], v. 13, n. 2, feb. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6275>. Date accessed: 12 apr. 2025.
doi: https://doi.org/10.18103/mra.v13i2.6275.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Childhood asthma
Oral theophylline
1. Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. Update 2014 and Online Appendix. Available at http://www.ginasthma.org.
2. Cisternas MG, Blanc PD, Yen IH, Katz PP, Earnest G, Eisner MD, Shiboski S, Yelin EH. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003; 111:1212–8.
3. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. (2017) 3:1.
4. Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014; 18:1269–78.
5. https://www.who.int/groups/global-alliance-against-chronic-respiratory-diseases-(gard)
6. Asher I, Haahtela T, Selroos O, Ellwood P, Ellwood E, Group GANS, others. Global Asthma Network survey suggests more national asthma strategies could reduce the burden of asthma. Allergol Immunopathol. (2017) 45:105–14.
7. Hossny E, Rosario N, Lee BW, Singh M. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organization Journal. Vol. 9. 2016, 26. Open access.
8. McCrossan P, Shields MD, McElnay JC. Medication Adherence in Children with Asthma. Patient Prefer Adherence. 2024 Mar 5; 18:555-564.
9. Stolbrink M, Thomson H, Hadfield RM, Ozoh OB, Nantanda R, Jayasooriya S, Allwood B, Halpin DMG, Salvi S, de Oca MM, Mortimer K, Rylance S. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Glob Health. 2022 Oct;10(10): e1423-e1442.
10. Meghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397.
11. Chuang S, Jaffe A. Cost considerations of therapeutic options for children with asthma. Paediatr Drugs. 2012 Aug 1;14(4):211-20.
12. Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low and middle-income countries: case for change. Eur Respir J. 2022 Se15;60(3):2103179.
13. Usmani OS, Lavorini F, Marshall J, Dunlop WCN, Heron L, Farrington E, et al. Critical inhaler errors in asthma and COPD: A systematic review of impact on health outcomes. Respir Res. 2018; 19:10.
14. Chawhan A, Thakrar D, Pinto L. Inhaler devices and their challenges - Helping patients use inhalers. Lung India. 2023 Jul-Aug;40(4):303-305.
15. Marques L, Vale N. Salbutamol in the Management of Asthma: A Review. Int J Mol Sci. 2022 Nov 17;23(22):14207.
16. Vichyanond P, Pensrichon R, Kurasirikul S. Progress in the management of childhood asthma. Asia Pac Allergy. 2012 Jan;2(1):15-25.
17. Kroegel C. Global Initiative for Asthma (GINA) guidelines: 15 years of application. Expert Rev Clin Immunol. 2009; 5:239–249.
18. Seddon P, Bara A, Ducharme FM, Lasserson TJ. Oral xanthines as maintenance treatment for asthma in children. Cochrane Database Syst Rev. 2006:CD002885.
19. Sullivan P, Bekir S, Jaffar Z, Page C, Jeffery P, Costello J. Anti-inflammatory effects of low-dose oral theophylline in atopic asthma. Lancet. 1994 Apr 23;343(8904):1006-
20. Tinkelman DG, Reed CE, Nelson HS, Offord KP. Aerosol beclomethasone dipropionate compared with theophylline as the primary treatment of chronic, mild to moderately severe asthma in children. Pediatrics. 1993 Jul;92(1):64-77.
21. Yurdakul AS, Taci N, Eren A, Sipit T. Comparative efficacy of once-daily therapy with inhaled corticosteroid, leukotriene antagonist or sustained-release theophylline in patients with mild persistent asthma. Respiratory Medicine 2003; 97, 1313–1319.
22. Daga S, Verma B, Mhapankar A, Kulkarni S, Kamble P. Theophylline in chronic asthma: A “before and after” study. The Internet Journal of Pediatrics and Neonatology. 2007 Volume 8 Number 1. Open access.
23. Razzak JA, Kellermann. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization 2002; 80:900-905.
24. Wilkinson A, Woodhouse A. The environmental impact of inhalers for asthma: A green challenge and a golden opportunity. Br J Clin Pharmacol 2022; 88:3016-30.
25. Woodcock A, Beeh KM, Sagara H. The environmental impact of inhaled therapy: making informed treatment choices. European Respiratory Journal 2022 60(1): 2102106.
Oral theophylline
1. Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. Update 2014 and Online Appendix. Available at http://www.ginasthma.org.
2. Cisternas MG, Blanc PD, Yen IH, Katz PP, Earnest G, Eisner MD, Shiboski S, Yelin EH. A comprehensive study of the direct and indirect costs of adult asthma. J Allergy Clin Immunol. 2003; 111:1212–8.
3. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. (2017) 3:1.
4. Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014; 18:1269–78.
5. https://www.who.int/groups/global-alliance-against-chronic-respiratory-diseases-(gard)
6. Asher I, Haahtela T, Selroos O, Ellwood P, Ellwood E, Group GANS, others. Global Asthma Network survey suggests more national asthma strategies could reduce the burden of asthma. Allergol Immunopathol. (2017) 45:105–14.
7. Hossny E, Rosario N, Lee BW, Singh M. The use of inhaled corticosteroids in pediatric asthma: update. World Allergy Organization Journal. Vol. 9. 2016, 26. Open access.
8. McCrossan P, Shields MD, McElnay JC. Medication Adherence in Children with Asthma. Patient Prefer Adherence. 2024 Mar 5; 18:555-564.
9. Stolbrink M, Thomson H, Hadfield RM, Ozoh OB, Nantanda R, Jayasooriya S, Allwood B, Halpin DMG, Salvi S, de Oca MM, Mortimer K, Rylance S. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review. Lancet Glob Health. 2022 Oct;10(10): e1423-e1442.
10. Meghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397.
11. Chuang S, Jaffe A. Cost considerations of therapeutic options for children with asthma. Paediatr Drugs. 2012 Aug 1;14(4):211-20.
12. Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low and middle-income countries: case for change. Eur Respir J. 2022 Se15;60(3):2103179.
13. Usmani OS, Lavorini F, Marshall J, Dunlop WCN, Heron L, Farrington E, et al. Critical inhaler errors in asthma and COPD: A systematic review of impact on health outcomes. Respir Res. 2018; 19:10.
14. Chawhan A, Thakrar D, Pinto L. Inhaler devices and their challenges - Helping patients use inhalers. Lung India. 2023 Jul-Aug;40(4):303-305.
15. Marques L, Vale N. Salbutamol in the Management of Asthma: A Review. Int J Mol Sci. 2022 Nov 17;23(22):14207.
16. Vichyanond P, Pensrichon R, Kurasirikul S. Progress in the management of childhood asthma. Asia Pac Allergy. 2012 Jan;2(1):15-25.
17. Kroegel C. Global Initiative for Asthma (GINA) guidelines: 15 years of application. Expert Rev Clin Immunol. 2009; 5:239–249.
18. Seddon P, Bara A, Ducharme FM, Lasserson TJ. Oral xanthines as maintenance treatment for asthma in children. Cochrane Database Syst Rev. 2006:CD002885.
19. Sullivan P, Bekir S, Jaffar Z, Page C, Jeffery P, Costello J. Anti-inflammatory effects of low-dose oral theophylline in atopic asthma. Lancet. 1994 Apr 23;343(8904):1006-
20. Tinkelman DG, Reed CE, Nelson HS, Offord KP. Aerosol beclomethasone dipropionate compared with theophylline as the primary treatment of chronic, mild to moderately severe asthma in children. Pediatrics. 1993 Jul;92(1):64-77.
21. Yurdakul AS, Taci N, Eren A, Sipit T. Comparative efficacy of once-daily therapy with inhaled corticosteroid, leukotriene antagonist or sustained-release theophylline in patients with mild persistent asthma. Respiratory Medicine 2003; 97, 1313–1319.
22. Daga S, Verma B, Mhapankar A, Kulkarni S, Kamble P. Theophylline in chronic asthma: A “before and after” study. The Internet Journal of Pediatrics and Neonatology. 2007 Volume 8 Number 1. Open access.
23. Razzak JA, Kellermann. Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization 2002; 80:900-905.
24. Wilkinson A, Woodhouse A. The environmental impact of inhalers for asthma: A green challenge and a golden opportunity. Br J Clin Pharmacol 2022; 88:3016-30.
25. Woodcock A, Beeh KM, Sagara H. The environmental impact of inhaled therapy: making informed treatment choices. European Respiratory Journal 2022 60(1): 2102106.