Chronotherapy of Asthma: How to Use Standard Medications for Better Results

Abstract

What exactly is the area of medical chronobiology, chronopharmacology, and chronotherapy? Actually, biologic rhythms are ubiquitous in nature. This includes plants and insects and proceeds through the phylogenetic ladder to humans. Chronobiology is defined as the scientific discipline that studies the intrinsic biologic rhythms of all life forms. The vast majority of physicians have never come into contact with the science of chronobiology either during their medical school or through their postgraduate training. What we have all faced is the concept that the human being is a homeostatic organism with a constant state of governing principles. Thus, in using therapeutic interventions for our patients we have actually been forced into the process of constant blood levels and equally divided dosing schedules throughout the 24-hour cycle. However, as more information about the nonhomeostatic processes involved in health and disease is learned, we are developing new principles on how to use common medications more appropriately and with better results. These nonhomeostatic processes that occur in humans are intrinsic biologic rhythms, which coordinate biochemical, endocrine, and physiological functions and have evolved to meet the differential requirements for energy substrates during activity or during the sleep-related hours. This concept of chronobiology is not new to medicine, but because it is a different type of view than the dominating theory of homeostasis it has not been widely taught to us as physicians treating diseases.As is becoming more evident, the conceptual and actual differences between the homeostasis and chronobiologic principles are not merely academic but can play a major role in disease and therapy. If we view our patients by the homeostasis principle, as already noted, it forces us to achieve consistency in therapeutic interventions and thus discredit different dosing schedules, that is, morning versus evening, as inconsequential with regard to either the pharmokinetics or the therapeutic results of a drug. As will become evident during this discussion, for respiratory diseases and therapeutic interventions this is not the case. Additionally, we are also learning that many if not all of the different organ systems in the body have circadian (occurring over a 24-hour cycle) changes in function and thus we will benefit from understanding specific diseases by a chronobiologic as well as a chronotherapeutic approach.

Biodistribution of Liposomes of Terbutaline Sulfate in Guinea Pigs

“…The best lung function occurs around 16:00, and the worst lung function occurs around 04:00, with about 8% change in the normal population (7). However, those with asthma can have much more dramatic decrements overnight in lung function than the normal population.…”