Theophylline, consider Corticosteroids

The concurrent use of theophylline and corticosteroids is common and therapeutically valuable, whereas the few reported interactions of theophylline with oral or parenteral corticosteroids are poorly documented and their clinical importance is difficult to assess because both increases, small decreases and no changes in the serum levels of theophylline have been seen. It is also questionable whether the results of studies in healthy subjects can validly be extrapolated to patients with status asthmatieus. There do not appear to be any data on the effect of inhaled corticosteroids on the clearance of theophylline. Both theophylline and corticosteroids can cause hypokalaemia, and the possibility that this may be potentiated by concurrent use should be considered. 

Theophylline is also considered an alternative to inhaled corticosteroids for the treatment of mild persistent asthma however, limited efficacy compared to inhaled corticosteroids, a narrow therapeutic index with life-threatening toxicity, and multiple clinically important drug interactions have severely limited its use. Theophylline causes bronchodilation through inhibition of phosphodiesterase and antagonism of adenosine and appears to have anti-inflammatory and immunomodulatory properties as well.36... 

Cromolyn or nedocromil may be considered as an alternative to inhaled corticosteroids in patients with symptoms occurring more than twice a week or who are wakened from sleep by asthma. They may also be useful in patients whose symptoms occur seasonally or after clear-cut inciting stimuli such as exercise or exposure to animal danders or irritants. In patients whose symptoms are continuous or occur without an obvious inciting stimulus, the value of these drugs can only be established with a therapeutic trial of inhaled drug four times a day for 4 weeks. If the patient responds to this therapy, the dose can be reduced. Maintenance therapy with cromolyn appears to be as effective as maintenance therapy with theophylline and, because of concerns over the possible long-term toxicity of systemic absorption of inhaled corticosteroids, has become widely used for treating children in the USA. 

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