If you’re one of the millions managing asthma, you’re likely familiar with the routine of using a preventer inhaler. But what if the timing of your dose could make a significant difference? A recent study published in the journal Thorax hints that taking a single dose of your inhaled corticosteroid (specifically, beclomethasone) in the mid-afternoon might just be the most effective way to keep those nighttime asthma symptoms at bay.
The idea is pretty straightforward: by aligning medication with your body’s natural clock – a concept called chronotherapy – you might be able to boost the medicine’s effects. Asthma, you see, has a daily rhythm. Airway obstruction and inflammation tend to peak overnight. This is when a large percentage of asthma attacks happen.
So, how did they figure this out? Researchers conducted a small clinical trial. They wanted to see if a single dose of a preventer inhaler in the afternoon would do a better job at suppressing nighttime asthma flare-ups compared to taking it in the morning or twice a day. They also kept an eye out for any increased risk of side effects from the steroid.
The study involved twenty-five adults with mild to moderate asthma and common allergies. Participants were assigned different dosing schedules for 28 days each. Some took 400 micrograms(µg) of beclomethasone between 8:00 AM and 9:00 AM. Others took the same dose between 3:00 PM and 4:00 PM. A third group took 200 µg twice daily, once between 8:00 AM and 9:00 AM and again between 8:00 PM and 9:00 PM.
Lung function and specific substances in the blood were measured every six hours during the day at the beginning and end of each 28-day period.
The results? All treatment plans improved nighttime lung function compared to the start of the study. However, the biggest improvement at 10:00 PM was seen with the single mid-afternoon dose which was 100ml more than the morning dose.
What about inflammation? All dosing schedules reduced airway inflammation, but the mid-afternoon dose came out on top again. It significantly lowered inflammation at 10:00 PM and 4:00 AM compared to the twice-daily dose. Plus, there were no significant differences in cortisol levels between the groups, suggesting no additional side effects from the different timings.
Now, the researchers are the first to admit that this was a small study, but they believe the results warrant further investigation in larger trials. They think that the best time to administer inhaled corticosteroids might be around 4:00 PM, which seems to coincide with when the body is most receptive to them.
Limitations of Findings
However, some experts point out that the mid-afternoon dose didn’t lead to better overall symptom control in this study. They suggest the study might have been too short, with too few participants, and that those involved had relatively mild asthma to begin with, leaving little room for improvement. They also note that the study didn’t include long-acting beta-agonist inhalers, a common treatment. Therefore, the findings might not apply to everyone with asthma. They also raised a point on how introducing a specific time for inhaler use could impact compliance to treatment since many people already struggle with it.
Despite these caveats, they agree that this study offers a look into the potential benefits of chronotherapy for asthma. They believe it could be most helpful for people with more severe asthma. In these cases, even small improvements in lung function could lead to better overall control and fewer risks.
This piece does not replace the professional opinion of your doctor. Always seek their professional advice before making any changes to your medication!