Abstract
Despite advances in asthma management, access to effective controller therapy remains limited in many low- and middle-income countries because of cost, availability, inhaler technique, and adherence barriers. Low-dose sustained-release theophylline possesses anti-inflammatory properties distinct from its traditional high-dose bronchodilator use and may offer a pragmatic alternative in resource-constrained settings. We reviewed evidence supporting the efficacy, safety, adherence, and affordability of low-dose sustained-release theophylline for asthma prevention, including a narrative review of published studies evaluating its use in asthma, with an emphasis on symptom control, safety, adherence, and cost considerations relevant to low-resource settings. Clinical studies have demonstrated improvements in symptom control, nocturnal asthma, peak expiratory flow, symptom free days, and reduced use of rescue medication. At serum concentrations below those traditionally used for bronchodilation, theophylline exhibits anti-inflammatory effects with a substantially lower incidence of adverse reactions. Oral administration may improve adherence compared with inhaled therapies in some settings. Available evidence also suggests substantially lower treatment costs than inhaled corticosteroid-based regimens. We conclude that, although inhaled corticosteroids remain the standard controller therapy, low-dose sustained-release theophylline remains an underutilized option. Reconsideration of its role as an adjunct or pragmatic alternative in selected low-resource settings may help address persistent inequities in access to asthma prevention. Contemporary clinical studies are needed to further define its place in asthma management.
What does this study add?
Low-dose sustained-release theophylline, used for its anti-inflammatory rather than bronchodilator effects, deserves re-evaluation as a controller option where access to standard inhaled therapies remains limited.