With the advent of new asthma inhalers that require only daily dosing, a question often asked is, when is the best time to take an asthma controller inhaler? This blog specifically refers to asthma inhaled corticosteroid inhalers and not rescue or emergency inhalers (albuterol), which should be used as needed or whenever asthma symptoms occur.
Asthma is a global health problem affecting all age groups and it is characterized by chronic airway inflammation. Inhaled corticosteroids have proved the most effective and essential therapy for asthma. Per guidelines, inhaled corticosteroids are the first-choice therapy for all patients with asthma that is not controlled by a rapid acting beta agonist (albuterol).
Lack of adherence and suboptimal use of inhaled steroids are associated with poor control of asthma. One of the main reasons for poor compliance is the dosing frequency of inhalers. Many inhalers require dosing twice a day. New inhalers that came on the market recently, now only require once daily dosing. Some of them are budesonide (Pulmicort), ciclesonide (Alvesco), mometasone (Asmanex) and fluticasone furoate (Arnuity). Once daily dosing as shown to be effective and well tolerated for asthma control and as effective as inhalers that need to be dosed twice a day.
Patients with asthma frequently experience night-time symptoms including cough, wheezing and shortness of breath, this can lead to sleep disruption. Lung function shows a circadian rhythm with lung function being lowest in the early morning. Serum cortisol follows a circadian rhythm, with peak concentrations between 6 and 10 AM and trough concentrations at night between 8 pm and 2 am.
A recent study published in the Annals of Allergy Asthma and Immunology, titled Impact of dosage timing of once-daily inhaled corticosteroids in asthma, looked into when is the best time to take a controller inhaler? With over 1200 subjects, the conclusion was once daily evening dosing resulted in mild improvements in lung function. Adverse events and use of rescue medicine was the same between morning and evening dosing times. The authors therefore recommend once daily evening administration.
Although only a mild improvement was shown, it probably is best to ask patients to take their controller medication at night if once daily dosing is needed. So if you are asking, when is the best time to take an asthma controller inhaler, its in the evening.
If your asthma is not under control, speak to your asthma doctor about your concerns and ways you can best manage it.