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Medical Forum / Diseases and Disorders / Asthma / November 2003black coffee better than albuterol
The following is a totally non-scientific personal anecdote, based on zero clinical trials! Yesterday I had some bad bronchspasm, chest really tight and hard to breath; it didn't respond to albuterol (same as salbutamol/ventolin), even after 6-7 puffs, there was very little improvement. An hour of so after the albuterol my breathing was still very difficult. I then had a cup of black coffee; within about ten minutes I noticed that my breathing had become much easier, lungs felt much less tight, in short, the coffee worked better than the albuterol at relieving the bronchospasm. I've noticed this reaction a number of times over the last few years; it seems to be quite consistent. The only time it doesn't work is when I have a viral infection, but albuterol hardly works at all then either. Any sort of coffee seems to work for me, even the cheapest, but the strong freeze-dried types work best. Can anyone tell me what's happening? Is it the caffeine that's having the beneficial effect? I don't get the same response from diet coke, although that has less caffeine than coffee. Or is it some other component in the coffee? I'm aware that the asthma drug theophylline is chemically similar to caffeine (both are members of a group of compounds called xanthines), however theophylline is a difficult drug to work with as it's very easy to get an overdose. Is the coffee/caffeine having a simlar effect to theophylline? Are there any other drugs which would have a similar effect? I greatly dislike the "hyped-up" feeling I get from caffeine; what I'd really like would be the therapeutic benefit of coffee without the 'caffeine wake-up effect'. I've tried de-caffeinated but it's not as effective as caffeinated, so I suspect the caffeine may be the main active agent. -- gumbo I sometimes find that a hot mug of tea is as good as ventolin. With tea I think the hot liquid accompanied with steam contributes to the beneficial effects. I bet you strong black coffe is not an espresso but a mug, and without milk its very hou and steamy? > The following is a totally non-scientific personal anecdote, based on > zero clinical trials! [quoted text clipped - 32 lines] > > -- gumbo > I sometimes find that a hot mug of tea is as good as ventolin. With tea I > think the hot liquid accompanied with steam contributes to the beneficial > effects. I bet you strong black coffe is not an espresso but a mug, and > without milk its very hou and steamy? Actually it still works even if it's just luke warm, I don't drink it too hot. I think it's some chemical in the coffee that's having the effect, possibly the caffeine. Put it this way, if I breath steam in from a pan of hot water it doesn't have any real effect on my bronchospasm, whereas even a mildly warm cup of coffee does. If you get the same effect from tea, maybe that supports the "caffeine hypothesis!" -- gumbo >> I sometimes find that a hot mug of tea is as good as ventolin. With tea I >> think the hot liquid accompanied with steam contributes to the beneficial [quoted text clipped - 7 lines] >whereas even a mildly warm cup of coffee does. If you get the same effect >from tea, maybe that supports the "caffeine hypothesis!" Caffeine is a bronchodilator that works through a different mechanism than albuterol. It is considered to be inferior to albuterol due to the systemic (vs. topical) nature of action and the side effects. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. >Caffeine is a bronchodilator that works through a different mechanism >than albuterol. It is considered to be inferior to albuterol due to >the systemic (vs. topical) nature of action and the side effects. I suppose it could be used in a pinch - IE: in a restaurant or at a friends and you can't get to your albuterol inhaler, but can easily get a cup of coffee. Cindi > I'm aware that the asthma drug theophylline is chemically similar to > caffeine (both are members of a group of compounds called xanthines), > however theophylline is a difficult drug to work with as it's very easy > to get an overdose. Is the coffee/caffeine having a simlar effect to > theophylline? Yes. Theophylline is not all that difficult to work with. These days we shoot for a lower range than they used to use (8-12 rahter than 10-20) and it helps keep the toxicity down while being just as effective. Also, there is no reason why you couldn't work it into the action plan and use intermittent dosing (kind of like you are doing with the coffee). > Are there any other drugs which would have a similar effect? I greatly > dislike the "hyped-up" feeling I get from caffeine; what I'd really like > would be the therapeutic benefit of coffee without the 'caffeine wake-up > effect'. I've tried de-caffeinated but it's not as effective as caffeinated, > so I suspect the caffeine may be the main active agent. One reason they use theophylline rather than caffeine tabs is that it produces less of the hyped up feeling. You may just be able to take an immediate release tab or two when having problems and avoid a lot of the side effects because the drug concentrations never build up to high levels. I have seen (and created) regimens where people increased or decreased their theophylline doses as their symptoms waxed and waned and I have even on occasion selected an antibiotic during flares with the intended side effect of increasing the theophylline level. -- CBI, MD > Theophylline is not all that difficult to work with. These days we shoot for > a lower range than they used to use (8-12 rahter than 10-20) and it helps > keep the toxicity down while being just as effective. Also, there is no > reason why you couldn't work it into the action plan and use intermittent > dosing (kind of like you are doing with the coffee). Thanks. I'll talk to my doc about giving theophylline another go. As I personally find the caffeine works where albuterol fails this may be really useful, especially if I can take it intermittantly as a symptomatic treatment as you suggest. Last time I tried theophylline, it made me feel very "wound up" - much more so than caffeine; perhaps I just had too high a dose. My doc said the problem with it is that it's easy to get the blood level too high, but if you have too little it has insufficient therapeutic effect. I think I was given sustained release theophylline, can't remember for certain as it was around four years ago; it was a dose before going to sleep to try to prevent nighttime waking. What daily dose would you recommend for an adult? Can you suggest any particular type/brand that you've found is well tolerated? Is sustained release best or immediate release? -- gumbo > What daily dose would you recommend for an adult? Can you suggest any > particular type/brand that you've found is well tolerated? Is sustained > release best or immediate release? If you are going to be taking it on a regular basis, i.e. every day, then clearly sustained release products are best. I haven't found a significant difference between the various products. The usual dose for an adult is about 400-600mg/day (possibly divided into two doses depending on the product) but this should be guided by response, symptoms, and levels. In general, and especially since you have been intolerant in the past, I would start low and see how you do. Theodur 100mg twice daily would be a good start and then go to 200mg twice daily if you are not having side effects. Then you could check a level and see where that puts you. Remember that the 8-12 range is a guideline, not a hard and fast rule. If you are getting a good effect at 4-7 I don't see much reason to push things. You could hold off and increase the dose somewhat when ill. If you are going to just add it in as needed then it makes more sense to use immediate release. The onset of action will be faster (but the duration shorter). Theophylline is a product that usually takes some time to build a level - we used to need to give "loading doses" when we used in acute situations routinely (usually in IV form as aminophylline) - so the dose you would need to take to get quickly up to a level of 8 would probably be quite large (something like 600mg). Since you get such a rapid effect from a cup of coffee I doubt you would need that much and probably would see a similar effect with 100-200mg of theophyline. There are several factors that can affect theophylline metabolism such as size, age, kidney function, liver function, congestive heart failure, and history of smoking so the treatment must be individualized and the drug levels regularly checked in chronic use. These issues are not nearly so important if a small dose is only taken intermittently. Also, theophylline can worsen GERD, tremors, and would be a bad idea in certain heart conditions and some others so this should obviously be discussed with your doctor. -- CBI, MD To CBI, Some asthmatics respond to Atrovent faily well. Think there is any correlation to Theophylline responders and those that might do well with Atrovent?  SignatureFM Respiratory Care Practitioner Asthma and Allergy Foundation of America-WA Branch > Theophylline is not all that difficult to work with. These days we > shoot for a lower range than they used to use (8-12 rahter than > 10-20) and it helps keep the toxicity down while being just as > effective. Also, there is no reason why you couldn't work it into the > action plan and use intermittent dosing (kind of like you are doing > with the coffee). > To CBI, > > Some asthmatics respond to Atrovent faily well. Think there is any > correlation to Theophylline responders and those that might do well with > Atrovent? I agree that some do. Atrovent (ipatropium) affects a different segment of the bronchial tree (larger airways) than beta agonsists and also can have the effect of drying secretions (which can be good or bad) so it is not surprising that it would help some people. In large studies it was not broadly beneficial so the group that it helps is probably pretty small but I have seen it. It seems to be particularly helpful in asthmatics who do or did smoke. I'm not aware of any correlation with people that do well on theophylline. -- CBI, MD Dear Gumbo: My daughter in law who is from Columbia, swears by coffee for relieving asthma discomforts. She claims the caffeine is a bronchodialator. Makes sense if you think about it. Red Hello everyone... I dont usually write or correspond with any groups... I just read them for information. But I wanted to reply to this letter because it hit close to home for me... I have had asthma for over 30 years. When I was young, dumb and "knew everything", I used methamphatamines (Speed) to cope with life... anyway, albuterol and many other medications were on my list of life savers at the time BUT what always worked was the drugs... or coffee.... for some reason when I always had to "Hope" the meds would work.. but the drugs ALWAYs did.... anyway, thats all I wanted to say.. I dont know what these two things had in common that always gave me relief.. I would like to know though if anyone has any ideas... Thanks ... Roberta PS- It took me a while but I did finally figure out that the bad effects were alot more than the good effects of drugs... and got help. Ive been clean for over years... Thanks again ... > Hello everyone... I dont usually write or correspond with any groups... I > just read them for information. But I wanted to reply to this letter because [quoted text clipped - 12 lines] > were alot more than the good effects of drugs... and got help. Ive been > clean for over years... Thanks again ... I wonder if methamphetamine has ever been investigated as an asthma drug? I expect the likely side-effects would rule it out. Does it work something like adrenalin, eg increase the amount you can breath when you're fleeing from some large animal predator? Anyway, very glad to hear you got off it, Roberta. -- gumbo > I have had asthma for over 30 years. When I was young, dumb and "knew > everything", I used methamphatamines (Speed) to cope with life... anyway, [quoted text clipped - 4 lines] > things had in common that always gave me relief.. I would like to know > though if anyone has any ideas... Thanks ... Roberta The speed causes a release of adrenaline and this is what was cousing the bronchodilation. Albuterol is basically adrenaline modified to open the lungs while having much less effect on the heart (but still can stimulate it). Inhaling it rather than taking it systemically enhances this selectivity. Caffeine and theophylline inhibit the enzyme that turns off the reaction (phospho diesterase). IOW - the albuterol and speed are stepping ont he gas while caffeine keeps your foot off the brake. SignatureCBI, MD |
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