Old Drug Holds New Promise


UVM's Asthma Clinical Research Center will be the lead site in a national trial to study theophylline, an inexpensive asthma medication prescribed since the 1970s but considered by researchers to have new potential. Called LODO for Effectiveness of Low Dose Theophylline, the new trial is sponsored by the 19 American Lung Association (ALA) Asthma Clinical Research Centers (ACRC) across the country and seeks to enroll more than 600 people, age 15 and over, who suffer from persistent asthma symptoms despite treatment. The ALA ACRC at UVM, headed by Charles Irvin, professor of medicine and director of the Vermont Lung Center, is the only ACRC in New England.

When theophylline, a pill-form treatment classified as a bronchodilator, was developed, clinicians believed it was necessary to prescribe high doses in order to open narrow, inflamed airway passages. "Back then, clinicians followed the strong coffee model of prescription," Irvin said. "They felt that, in order to get the maximum effect, they needed to prescribe the maximum strength." The medication, which became associated with side effects and drug interactions, fell out of favor when newer treatment options became available.

Scientists have decided to give theophylline another chance. Recent studies in such scientific journals as The Lancet and the American Journal of Respiratory Critical Care Medicine suggest that theophylline may have the capacity to reduce airway inflammation and clear away mucus in reduced doses one-quarter to one-third of those needed to open asthmatic passages.

The LODO study seeks to identify whether or not theophylline can be an effective add-on therapy that will produce better overall results for asthmatics. In order to compare the effects and safety of low doses of theophylline, the study also is looking at the effects of Montelukast (sold as Singulair), as well as a placebo, on asthma patients. During the study, the patient, the investigator and the staff will not know which treatment each participant receives. Over the course of six months, study participants will take one capsule with dinner each evening. They also will record their peak expiratory flow daily, measured by how fast they can blow out.

Then they will take their regular daily medication, usually an inhaled steroid. "About a third of all asthma sufferers are unable to manage their asthma well," Irvin said. Secondary benefits to this drug, he said, are "the convenience of a pill versus an inhaler, and the fact that Theophylline is very inexpensive. The days activities will include free, two-minute breathing tests; asthma treatment mini-seminars; "Faces of Asthma," a slideshow featuring celebrities with asthma; access to asthma experts; and educational displays and literature. Information about the LODO trial: Mary Lynn, 847-2193.

 

 

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