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This combination therapy, evaluated by Baqiyatallah Medical Sciences University, consists of a macrolide, theophylline, and inhaled corticosteroids (ICS) for the treatment of chronic obstructive pulmonary disease (COPD), particularly in smokers. Macrolides are included for their immunomodulatory and anti-inflammatory properties beyond their antibacterial activity. Theophylline acts as a bronchodilator via phosphodiesterase inhibition and adenosine receptor antagonism; importantly, it also enhances the activity of histone deacetylase 2 (HDAC2), which can restore corticosteroid sensitivity in COPD patients. Inhaled corticosteroids provide potent local anti-inflammatory effects by activating the glucocorticoid receptor. This triple combination aims to address the complex inflammatory environment and steroid resistance often seen in COPD.
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