Continuous intravenous therapy with theophylline in patients with brittle bronchial asthma.

I read with interest the case report (Spielberg and van Denbrink, Eur Respir J., 1, 471-472) from Davos on a patient with brittle asthma treated with a continuous infusion of theophylline. I was surprised to see that our paper on the treatment of brittle asthma with continuous subcutaneous infusions of terbutaline was not referred to [1]. Since that preliminary study which showed excellent control of brittle asthma, a follow-up study about to be published in the British Journal of Diseases of the Chest [2], shows that about 50% of patients with brittle asthma respond very well to subcutaneous terbutaline infusion, and a further 25% improve considerably although not to such a successful degree. One of the main criteria that we use for assessment is the variability in daytime peak flow readings. I was intrigued to see that the patient described by Spielberg and van Denbrink appear to use this as an assessment of the success of therapy. We believe that patients with brittle asthma have down regulated beta receptors and the surprising thing about these patients is how few side effects they develop while on such treatment, which achieves relatively high levels of terbutaline. We believe that this form of treatment is very useful in brittle asthma and we would rather use beta agonists than theophylline.<> in this situation in view of their lack of side effects.