TWICS: A randomised, double-blind placebo controlled trial of the effectiveness of low dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease

This pragmatic randomised clinical trial aimed to test whether a low-dose theophylline reduce the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD) when added to inhaled corticosteroids (routine COPD treatment). 1567 participants were recruited in 121 primary and secondary care sites around the UK. 788 participants were randomised to low dose theophylline and 779 to placebo. The trial arms were well balanced; mean age 68 years, 46% were women, 32% currently smoked, and the mean FEV1 was 52%.

Low-dose theophylline had no significant effects on lung function (FEV1), incidence of pneumonia, mortality, breathlessness, or measures of quality of life or disease impact. Hospital admissions because of COPD were less frequent with low-dose theophylline, (28% reduction) however, most of this was a consequence of a 10 participants being admitted 3 or more times to hospital. There were no differences in the reporting of theophylline side effects between the theophylline and placebo arms.

The importance and success of TWICS is that it has provided the highest quality evidence that we should not be using low-dose theophylline as adjunctive therapy to inhaled corticosteroids for the prevention of COPD exacerbations.

The study results are published in JAMA October 2018


Results of the NIHR funded PACE study, delivered with the help of nine GP surgeries in the East of England region, have now been published in the New England Journal of Medicine, Jul 2019. The PACE study looked at Primary Care use of a C-Reactive Protein Point of Care Test to help target antibiotic prescribing to patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease who are most likely to benefit. Click here to read the paper.

3C Cough Complications Cohort Study

The study aimed to determine if subsequent diagnosis of pneumonia following presentation in primary care with a cough and a diagnosis of lower respiratory tract infection (LRTI) can be predicted from clinical characteristics and to determine if antibiotic treatment is associated with reduced incidence of adverse outcome.

The study concluded that prescribing antibiotics to reduce subsequent hospitalisation or death for adults with uncomplicated LRTI cannot be justified – delayed prescription may be preferable since it is associated with reduced re-consultations with worsening illness.

A paper on the predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia is published in European Respiratory Journal and a paper on the antibiotic prescription strategies and adverse outcome for uncomplicated respiratory tract infections is published in The BMJ.


Towards person-centred care: development of a patient support needs tool for patients with advanced chronic obstructive pulmonary disease (COPD) in primary care (SNAP1 Study) aimed to develop a new Support Needs Approach for Patients (SNAP) tool, suitable for use in clinical practice. A comprehensive range of evidence-based domains of support were identified for inclusions in the draft SNAP tool. The tool asks patients to consider whether they need more support in relation to 16 domains of support need e.g. practical help in the home, knowing what to expect in the future, understanding their condition, getting out and about, and support for their carer.

The study findings are published in THORAX.