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Rapid effect of inhaled steroids on nocturnal worsening of asthma

Department of Medicine, University of S Paulo Medical School at Ribeirão Preto, Brazil

Correspondence to:
Correspondence to:
Dr E O Vianna, Pulmonary Division, Department of Medicine, University of S. Paulo Medical School at Ribeirão Preto, Av. Bandeirantes 3900, Ribeirão Preto, SP 14048.900, Brazil;
evianna{at}uol.com.br

ABSTRACT
Background: Inhaled steroids are the most commonly used anti-inflammatory agents for asthma and are increasingly recognised as having a more rapid onset of action than was previously thought. We have investigated the effect of a single dose of inhaled steroid on nocturnal worsening of asthma.

Methods: Ten patients with steroid naive moderate asthma and nocturnal asthma participated in a randomised, double blind, placebo controlled, crossover trial. Participants spent three nights in the laboratory, one week apart. On each night they underwent spirometric testing at 16.00 hours and received one of the three treatments (placebo, beclomethasone 1000 µg, or fluticasone 1000 µg) delivered by metered dose inhaler. Spirometric tests were repeated at 04.00 hours the following morning.

Results: Following placebo administration the mean (SE) overnight fall in FEV₁ was 0.65 (0.27) l compared with –0.02 (0.13) l following fluticasone (p=0.019) and 0.23 (0.12) l following beclomethasone (p=0.048 v placebo).

Conclusion: A single dose of inhaled steroid (within the therapeutic range) reduced the fall in FEV₁ in patients with nocturnal asthma when administered at 16.00 hours. Nocturnal worsening of asthma is a useful model for testing inhaled steroid activity in a single night study.

Keywords: asthma; circadian rhythm; inhaled corticosteroids

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