A home care patient with chronic Obstructive Pulmonary Disease reports an upset stomach.

الشرح

Core Concept: Theophylline (Theo-dur) is a methylxanthine bronchodilator used in COPD and asthma. It is known to cause gastrointestinal irritation, leading to nausea, vomiting, and epigastric distress, especially when taken on an empty stomach.

Clinical Presentation:

• Classic symptoms: Nausea, vomiting, stomach upset, and in cases of toxicity, tachycardia, tremors, and seizures.
• Complications: Theophylline toxicity (due to its narrow therapeutic index).

Diagnosis:

• First-line diagnostic plan/tool: Clinical assessment of GI symptoms and review of medication history.
• Most accurate (gold standard) diagnostic test: Serum theophylline level monitoring to ensure it remains within the therapeutic range (10-20 mcg/mL).

Management:

• Acute management: To minimize gastrointestinal upset, patients should be counseled to take oral theophylline preparations with food, milk, or crackers.
• Gold standard long-term/definitive management: Regular monitoring of serum theophylline levels, as factors like diet, smoking status, and concurrent illnesses can alter its metabolism. Inhaled corticosteroids (like Azmacort) should be used as prescribed, and the mouth should be rinsed after use to prevent oral candidiasis.