Post-tuberculous lung disease: should we be using Theophylline?

Sumanth Karamchand; Morne Williams; Poobalan Naidoo; Eric Decloedt; Brian Allwood

doi:10.21037/jtd-20-1298

Post-tuberculous lung disease: should we be using Theophylline?

J Thorac Dis. 2021 Feb;13(2):1230-1238. doi: 10.21037/jtd-20-1298.

Authors

Sumanth Karamchand¹, Morne Williams¹, Poobalan Naidoo², Eric Decloedt³, Brian Allwood¹

Affiliations

¹ Division of Pulmonology, Western Cape Department of Health, Tygerberg Hospital, Bellville, South Africa.
² Department of Informatics, School of Health Professions, Rutgers University, New Jersey, USA.
³ Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa.

Abstract

Tuberculosis affects 10 million people and over 320,000 South Africans every year. A significant proportion of patients treated for tuberculosis develop post-tuberculous lung disease (PTBLD), a disease of chronic respiratory impairment for which there is a lack of affordable treatment options. PTBLD a heterogenous disorder that shares phenotypical features with chronic obstructive lung disease, bronchiectasis, lung fibrosis and destruction as well as pulmonary hypertension. There remains a paucity of proven pharmacotherapy for the management of PTBLD. Theophylline, a widely available and affordable medicine that has largely fell out of favour in high-income settings due to its toxicity and narrow therapeutic index, may be repositioned for the treatment of PTBLD. In this review, we unpack the potential role of theophylline in the management of PTBLD by reviewing the evidence for its bronchodilatory, anti-inflammatory and potential pleotrophic effects.

Keywords: Post tuberculous lung disease (PTBLD); chronic obstructive pulmonary disease (COPD); pulmonary hypertension; theophylline; tuberculosis (TB).

Publication types

Review