title: Quantitative characterization of circadian rhythm of pulmonary function in asthmatic patients treated with inhaled corticosteroids.
abstract: The aim of this study was to characterize the circadian rhythm observed for forced expiratory volume in 1 s (FEV1) in patients with persistent asthma being treated with inhaled corticosteroids. The database included 3379 FEV1 measurements from 189 patients with mild to moderate asthma. A model using the sum of two Sine functions with periods of 12 and 24 h and a constant component of mean circadian rhythm adequately described the circadian rhythm in FEV1 measurements over time. The model adequateness was evaluated by various approaches including visual predictive check (VPC), prediction-corrected VPC, standardized VPC and normalized prediction distribution error. Covariates tested included age, body weight, height, body mass index, baseline FEV1, and sex. Age and height were found to have significant effects on the mean FEV1 level and no covariate was found to have an effect on the magnitude and timing of circadian rhythm. The model predicted that a minimum FEV1 occurred in the early morning and maximum FEV1 occurred in the early afternoon, with a population mean fluctuation of 170 mL, which is consistent with the finding that asthma symptoms usually exacerbate in the early morning for patients with persistent asthma. This developed model provides the first quantitative approach to describing FEV1 circadian rhythm with ICS background treatment and provided insight in designing future registration trials for asthma drug development.
authors.affiliation: Department of Pharmaceutics, College of Pharmacy, University of Florida, 1600 SW Archer Road, Gainesville, FL, USA.
authors.forename: Di
authors.initials: D
authors.lastname: Zhou
authors.forename: Hongshan
authors.initials: H
authors.lastname: Li
authors.forename: Yaning
authors.initials: Y
authors.lastname: Wang
authors.forename: Guenther
authors.initials: G
authors.lastname: Hochhaus
authors.forename: Vikram
authors.initials: V
authors.lastname: Sinha
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012720:Severity of Illness Index; D013147:Spirometry; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D006854:Hydrocortisone