Timing the use of a commonly prescribed asthma inhaler in the mid-afternoon could lead to improved clinical outcomes, according to new research led by the University of Manchester.
The study, published in the journal Thorax, found that a once-daily dose of inhaled beclomethasone was most effective when taken between 3pm and 4pm.
The findings suggest that aligning asthma medication with the body’s natural circadian rhythms could enhance its effectiveness without increasing the dose.
Conducted at the Medicines Evaluation Unit at Wythenshawe Hospital and funded by the Jon Moulton Charity Trust, this study builds on previous research by the same team, which found that immune cells displayed heightened steroid sensitivity at 4pm compared to 4am.
The researchers believe the latest findings add further support to the hypothesis that the body’s inflammatory cascade tends to intensify in the mid-afternoon.
Lead researcher Dr Hannah Durrington, honorary consultant physician at Manchester University NHS Foundation Trust and senior clinical lecturer and Medical Research Council clinician scientist at the University of Manchester, said the findings could have implications for both patient outcomes and treatment planning.
‘Up to three quarters of patients experience worsening symptoms overnight, and up to 80% of fatal asthma attacks occur at night,’ she said.
‘This study shows that aligning the timing of beclomethasone with the body clock could have significant impacts on treatment outcomes, and this occurred without any of the associated adverse effects or costs of taking higher doses of steroids.’
Comparing morning and afternoon regimens with standard practice
The randomised cross-over study – which was supported by the NIHR Manchester Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC – involved 21 patients who each received three different dosing regimens over 28-day periods, separated by two-week washouts.
Participants were administered 400µg once-daily between 8am and 9am for regimen one, once-daily between 3pm and 4pm for regimen two, and the third was 200µg twice-daily (8am/8pm) – the standard regimen in UK practice.
Researchers assessed lung function blood eosinophil counts and serum cortisol levels.
The mid-afternoon dose led to the largest overnight improvement in lung function and significantly greater suppression of eosinophils, compared to both morning-only and standard twice-daily regimens.
Dr Durrington believes the results offer promising avenues for developing personalised approaches to asthma care.
‘Our findings provide key opportunities for novel chronotherapeutic development in asthma, leading to the possibility of tailored therapy based on individuals’ preference in timing of drug administration and their biological rhythm in disease,’ she said.
The research team is now calling for larger-scale trials to assess the to establish clinical feasibility in a real-life setting and to evaluate the health and economic impacts.
A version of this article was originally published by our sister publication Nursing in Practice.
