Methylxanthines for exacerbations of chronic obstructive pulmonary disease: meta-analysis of randomised trials

The authors conclusion that "the available data do not support the
use of methylxanthines for treatment of COAD exacerbations" is an
overgeneralisation. It should read "the available data on using
methylxanthines as adjunct therapy to standard inhaler therapy in the
treatment of COAD exacerbations does not support their use as add on
therapy"

Many patients in developing countries receive methylxanthines as
monotherapy. Inhaled therapy is expensive and methylxanthines are cheap.
It would be very helpful to know if monotherapy with methylxanthines is
ineffective. However this question cannot be answered by the present
study, but the conclusion implies it is.

It is not unscientific to speculate that monotherapy with
methylxanthines may have therapeutic benefit. By way of simplistic
illustration, adding an NSAID to a regime of paracetamol for
osteoarthritis may confer no extra analgesia, but it would be wrong to
conclude from this that NSAIDs as monotherapy dont work. A similar example
would be adding an H2 antagonist to a regime containing a PPI.

Competing interests:  
None declared