Asthma: evening may be the optimal time for ICS inhalation

Takeaway

• A meta-analysis suggests once-daily inhaled corticosteroids (ICS) administered in the evening was associated with mild improvements in lung function for trough FEV1 and morning peak expiratory flow (PEF) at endpoint compared with morning dosing.
• The use of rescue medicine and adverse event rates were similar with both dosing strategies.

Why this matters

• Lack of adherence of ICS therapy is an issue.
• Once-daily dose was not inferior to the same total dose given twice daily.
• It is unclear if dose timing affects efficacy of treatment.
• Large randomised clinical trials for dosing time of once-daily ICSs are warranted.

Study design

• 8 studies (1234 patients with asthma) were identified after a search on Medline, Embase, and the Cochrane Central Register.
• 628 patients received once-daily ICS in the morning and 606 patients in the evening.
• Funding: Jeju National University.

Key results

• Once-daily evening dose of ICS improved the trough FEV₁ (mean difference [MD], 0.05 L; 95% CI, 0.01-0.09; P=.026) and morning PEF at endpoint (MD, 13.92 L/min; 95% CI, 5.77-22.06; P=.001) vs morning dose.
• Both morning and evening doses were associated with similar use of rescue medicine (MD, ─0.14; 95% CI, ─0.41 to 0.12; P=.291) and the incidence of any adverse events (34.8% vs 31.9%; P=.382).

Limitations

• Small studies included in the meta-analysis.