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Manchester, UK – April 16, 2025 – Optimising the timing of asthma medication could significantly improve treatment outcomes, according to a new study led by researchers at The University of Manchester. The findings, published today in the journal Thorax, suggest that taking the commonly prescribed beclomethasone steroid inhaler, often known as the ‘brown inhaler’ (Clenil Modulite® in the UK), between 3 PM and 4 PM may offer the greatest benefit.
The research, funded by the Jon Moulton Charity Trust and conducted at the Medicines Evaluation Unit (MEU) at Wythenshawe Hospital, is the first to demonstrate how aligning this specific asthma treatment with the body’s natural circadian rhythms can impact daily physiological and immunological responses. The study received support from the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC.
Asthma affects millions globally, with around 7.2 million people in the UK diagnosed, according to Asthma + Lung UK. Characterised by wheezing, breathlessness, coughing, and chest tightness, the condition currently has no cure, but symptoms are typically managed with inhalers and other medications. Many patients, however, experience worsening symptoms overnight.
“Up to three quarters of patients experience worsening symptoms overnight and up to 80% of fatal asthma attacks occur at night,” explained lead researcher Dr. Hannah Durrington, Senior Clinical Lecturer at The University of Manchester and honorary consultant physician at Manchester University NHS Foundation Trust.
The study builds on previous work by the team from 2023, which indicated enhanced steroid sensitivity in immune cells around 4 PM. It also supports the theory that the body’s inflammatory processes may initiate in the mid-afternoon.
In this cross-over study, 21 patients followed three different dosing schedules, each for 28 days with a washout period in between:
- A single 400µg dose between 8 AM and 9 AM.
- A single 400µg dose between 3 PM and 4 PM.
- The standard UK twice-daily dose of 200µg (between 8-9 AM and 8-9 PM).
Researchers measured lung function, blood eosinophil counts (a key marker for airway inflammation), and serum cortisol levels.
The results showed that the single dose administered between 3 PM and 4 PM led to the most significant increase in overnight lung function and the greatest overnight suppression of blood eosinophils compared to both the morning-only dose and the standard twice-daily regimen.
“This study shows that aligning the timing of beclomethasone – ‘the brown inhaler’ a commonly taken asthma treatment – with the body clock could have significant impacts on treatment outcomes,” Dr. Durrington stated. “And this occurred without any of the associated adverse effects or costs of taking higher doses of steroids.”
Co-author Dr. Ran Wang, an NIHR Clinical Lecturer also at The University of Manchester, added perspective on the potential for personalised medicine: “Our findings provide key opportunities for novel chronotherapeutic development in asthma, leading to the possibility of tailored therapy based on individuals’ preference in timing of drug administration and their biological rhythm in disease.”
While the findings are promising, the researchers emphasize the need for further validation. “Our findings warrant further validation in a larger clinical trial to establish clinical feasibility in a real-life setting and to evaluate the health and economic impacts,” concluded Dr. Durrington.
Disclaimer: This article reports on findings from a specific scientific study. The information provided is for general knowledge and informational purposes only, and does not constitute medical advice. Patients should not change their medication schedule or dosage without consulting their doctor or qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
