Low-Dose Sustained-Release Theophylline in Asthma Prevention: A Pragmatic Option for Resource-Constrained Settings

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.