title: Further studies on the chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy.
abstract: BACKGROUND
  Chronotherapy studies with inhaled corticosteroids have shown optimal therapeutic benefit when steroids are administered four times per day (QID) or once daily at 3 PM.
  
  
  OBJECTIVE
  This study evaluated whether more convenient once-daily dosage times (8 AM and 5:30 PM) produce improvement in asthma equivalent to QID.
  
  
  METHODS
  Efficacy outcome measures included FEV1, peak expiratory flow rates, bronchial responsiveness, use of beta2-agonists, nocturnal awakenings, and responses to a quality of life questionnaire. Systemic effects were blood eosinophil count, cortisol level, 24-hour urinary cortisol, and evaluation for oral candidiasis and dysphonia.
  
  
  RESULTS
  Baseline measurements for all three treatment groups were similar. For morning peak expiratory flow rate, significant improvement was seen for the QID group (p = 0.001) and the 5:30 PM group (p = 0.003), but not the 8 AM group (p = 0.75). For evening peak expiratory flow rate, significant improvement was seen for the QID group (p = 0.005) and the 5:30 PM group (p = 0.01), but not for the 8 AM group (p = 0.47). There were significant improvements in all other outcome variables for each group except PC20. There was a significant improvement in PC20 only in the QID group. The systemic effects of the three regimens were comparable.
  
  
  CONCLUSIONS
  Dosing of inhaled steroid at 5:30 PM had no increased systemic effects and produced efficacy similar to QID dosing. Dosing at 8 AM did not produce results consistently comparable to QID dosing. Optimal once-daily dosing of inhaled steroid is between 3 PM and 5:30 PM.
authors.affiliation: Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Pincus
authors.forename: T R
authors.initials: TR
authors.lastname: Humeston
authors.forename: R J
authors.initials: RJ
authors.lastname: Martin
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001143:Arousal / Q000187:drug effects; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D019454:Chronotherapy / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D000318:Adrenergic beta-Agonists; D014222:Triamcinolone Acetonide