Expert Opinion on Controlled-release Theophylline as an Add-on Therapy in the Management of Chronic Obstructive Pulmonary Disease and Asthma

In India, asthma and chronic obstructive pulmonary disease (COPD) are leading chronic respiratory disorders that play a major role in causing morbidity and mortality. This expert opinion focuses on reevaluating the role of controlled release (CR) theophylline in managing both COPD and asthma. Respiratory consulting meeting was held in Mumbai on August 4, 2024. Ten expert pulmonologists gave insights on: (i) the mechanisms of action of theophylline, (ii) its multifaceted clinical benefits, (iii) add-on use of theophylline with inhalers, (iv) safety and tolerability of CR theophylline, (v) guideline recommendations, and (vi) future perspectives. A follow-up meeting on February 23, 2025, was conducted with the same experts to review, examine, and validate the expert opinion statements for accuracy and validity. Experts recommended that (i) CR theophylline should be used as add-on therapy for better clinical outcomes, (ii) it offers multifaceted benefits in obstructive airway diseases and may be considered before stepping up steroid doses, (iii) its anti-inflammatory effects occur at 5–10 µg/mL, while bronchodilation at 10–15 µg/mL, and (iv) compared to conventional theophylline, CR theophylline has a better safety profile and warrants inclusion in treatment guidelines based on risk–benefit assessment. In the treatment of COPD and asthma, CR theophylline acts as an adjunctive therapy when prescribed in an optimum dosage regimen and formulated using an efficient technique.