Is there a role for oral bronchodilators in COPD

Oral b-agonists such as salbutamol, terbutaline or bambuterol have been shown to have bronchodilator activity in COPD. However, oral b-agonists tend to cause side-effects such as tremor. Inhaled b-agonists can produce equivalent or superior bronchodilation for most patients with less side-effects.

Oral theophylline has been shown to have a modest bronchodilator effect in COPD. However, inhaled b-agonists, especially long-acting b-agonists, achieve greater bronchodilation with less risk of toxicity. In patients with severe symptoms, there may be some benefit from the combination of inhaled salmeterol supplemented by oral theophylline (but side-effects were also increased) [11].

It has been suggested that the best way to decide on optimal therapy for COPD patients is to conduct 'n or one' trials where additional drugs such as theophylline are introduced and withdrawn under careful medical scrutiny. However, conventional practice may be just as effective in identifying the subset of patients who respond to theophylline (about 20%) [17]. Each additional agent should be continued long-term only if the patient and the clinician are convinced that the additional agent has added worthwhile benefit for the patient.

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