Guideline topic: Pharmacological management of asthma
Evidence table 4.4a: Inhaled corticosteroid vs theophylline

Author

Young People and Adults

Galant¹

1996

Randomised, double-blind placebo, parallel group

12 week treatment period

++

N=353

Age 12 –75

19 centres

Fluticasone 50ug bd, 100ug bd vs theophylline

1] change in FEV1

2] change in FVC

3] am PEF

4] salbutamol use

5] symptoms

6] night awakenings

FP 50 ug bd vs theophylline

0.66L vs 0.37L

0.63L vs 0.30L

54 vs 21 L/min

-1.7vs –0.9/day

-0.6 vs – 0.3

-0.2 vs –0.1

p<0.004

p<0.003

p<0.001

NS

p<0.001

NS

FP 50 ug bd was more effective than theophylline in improving lung function and asthma control. There was no difference between FP 50ug bd and FP 100ug bd.

Matthys²

1994

Randomised, double-blind cross-over

6 week treatment+

+

N=8

Adults

Single centre

Budesonide

400ug bd vs theophylline 800 mg od

1] PEF

2] FEV1

3] Carbachol challenge

4] BAL

5] beta-agonist use

Budesonide vs theophylline 460 vs 439 L/min

3.27 vs 3.32L

0.92 vs 0.74 kPa/ls

No difference in cell counts

1.16 vs 1.97

NS

NS

NS

NS

NS

Very small sample size.

No statistical difference between budesonide and theophylline. Study probably underpowered to demonstrate differences.

Reed³

1998

Randomised, double-blind, double-dummy, parallel group

12 month treatment period

++

N=747

Children + adults age 6-65 yrs

Beclomethasone 84ug qid ms theophylline bd

1] Symptom score

2] Severe symptoms

3] PEF

4] Beta-agonist use

5] Steroid use

6] Doctor visits

7] Days off

BDP vs theophylline

Less with BDP

20 vs 31%

No difference in PEF

Less use with BDP

20% vs 29%

19.2% vs 19.8%

24% vs 23%

P=0.002

P=0.002

NS

P<0.05

p<0.05

NS

NS

Although there was no difference in PEF, overall, BDP was more effective than theophylline in asthma control.