Thorax

Inhaled corticosteroid dosing in asthma: Does time of day matter?

April 18, 2025

Study details: This randomized three-way crossover trial evaluated the impact of dosage timing for inhaled corticosteroids (ICS) in 25 participants with mild to moderate atopic asthma. Participants were assigned to three regimens of beclometasone dipropionate: 400 µg once daily in the morning (OD AM), 400 µg once daily in the afternoon (OD PM), and 200 µg twice daily (BID). Each regimen lasted 28 days, with a 2-week washout period between treatments.

Results: Of the 25 participants, 21 completed all regimens. The OD PM regimen significantly improved lung function at 22:00 (FEV1: +160 ml) compared with OD AM (−20 ml) and BID (+80 ml). OD PM also showed superior overnight suppression of blood eosinophil counts compared with the other regimens. All dosing schedules improved asthma control and reduced fractional exhaled nitric oxide and serum cortisol levels, with no significant differences in adverse events.

Clinical impact: Evening dosing of ICS may better address nocturnal worsening of asthma symptoms and inflammation, potentially offering a more effective approach to asthma management. Further trials are needed to confirm these findings in broader patient populations and real-life settings.

Source:

Wang R, et al. (2025, April 15). Thorax. The impact of dosage timing for inhaled corticosteroids in asthma: a randomised three-way crossover trial. https://pubmed.ncbi.nlm.nih.gov/40234005/