Afternoon could be best time for asthma inhaler, study shows
A mid-afternoon puff could be the best way to get the most out of your asthma inhaler according to a new study led by University of 野狼社区 researchers.
The study, funded by the Jon Moulton Charity Trust, found that a dose of inhaled beclomethasone - known as Clenil Modulite庐 or the 鈥榖rown鈥� steroid inhaler in the UK- could lead to better clinical outcomes if taken between 3pm and 4pm.
The study was carried out in the Medicines Evaluation Unit (MEU) at Wythenshawe Hospital with support from both the National Institute for Health and Care Research (NIHR) 野狼社区 Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC.
It is the first to show the effect of coordinating a commonly used asthma treatment with the body's circadian rhythms 鈥� or body clock- on daily physiological and immunological changes.
It follows on from a 2023 by the research team which demonstrated enhanced steroid sensitivity in immune cells at 4PM compared to 4AM.
It also supports the theory that the onset of the inflammatory cascade - a complex series of chemical reactions occurring within the body leading to inflammation and healing - begins in the mid-afternoon.
According to Asthma +Lung UK, around 7.2 million Brits have asthma or 8 in every 100 people.
People with asthma suffer from wheezing, breathlessness, and a cough or a tight chest which are triggered by things like exercise, allergens or changes in weather.
At the moment there is no cure for asthma, though most people with asthma can control their symptoms using asthma inhalers and other medicines.
The study, published in Thorax (16/04/25), was led by Dr Hannah Durrington, Senior Clinical Lecturer and MRC Clinician Scientist at The University of 野狼社区 and honorary consultant physician at 野狼社区 University NHS Foundation Trust , along with Dr Ran Wang, an NIHR Clinical Lecturer, also at the University of 野狼社区.
This study shows that aligning the timing of beclomethasone 鈥� 鈥榯he brown inhaler鈥� a commonly taken asthma treatment - with the body clock could have significant impacts on treatment outcomes
Dr Durrington said: 鈥淯p to three quarters of patients experience worsening symptoms overnight and up to 80% of fatal asthma attacks occur at night.
鈥淭his study shows that aligning the timing of beclomethasone 鈥� 鈥榯he brown inhaler鈥� a commonly taken asthma treatment - with the body clock could have significant impacts on treatment outcomes.
鈥淎nd this occurred without any of the associated adverse effects or costs of taking higher doses of steroids.
鈥淥ur findings warrant further validation in a larger clinical trial to establish clinical feasibility in a real-life setting and to evaluate the health and economic impacts.鈥�
The 21 patients in this cross-over study received the 400碌g dose once-daily between 8AM and 9AM; once-daily between 3PM and 4PM; and 200碌g twice-daily between 8AM and 9AM and between 8PM and 9PM- the 鈥榰sual鈥� pattern of dosing in the UK.
All patients received the three regimes in a randomized order for 28 days, with a 2-week washout period between treatment periods.
The scientists tested lung function and blood eosinophil counts -a key biomarkers for airway inflammation - and serum cortisol levels to assess health outcomes.
The mid-afternoon dose resulted in the largest increase in overnight lung function and a significant overnight suppression in blood eosinophil counts compared to once-daily morning and standard twice-daily dosing regimes.
Dr Durrington added: 鈥淥ur findings provide key opportunities for novel chronotherapeutic development in asthma, leading to the possibility of tailored therapy based on individuals鈥� preference in timing of drug administration and their biological rhythm in disease.鈥�
The paper The impact of dosage timing for inhaled corticosteroids in asthma: a randomised 3-way crossover trial is published in , DOI/10.1136/thorax-2024-222073