Chest
Nocturnal Asthma
Section snippets
Clinical Associations
Gastroesophageal reflux disease (GERD) is commonly associated with nocturnal asthma symptoms. A recent cross-sectional study provides new information on these interactions. More than 2,600 subjects were evaluated, including > 450 who had an existing diagnosis of asthma. GERD symptoms were consistently defined, and they occurred in 4.6% of the sample population. Subjects with GERD were significantly more likely to have nighttime wheezing and breathlessness, and to report nocturnal cough and
More Severe Asthma or a Separate Entity?
A key, and recurring, question in the field of nocturnal asthma is whether patients with nocturnal asthma simply have asthma that is more severe (with nocturnal symptoms being one indicator of severity) or have a qualitatively different disorder. Data exist on both sides of this question, so a definitive answer is not currently available.
The results of several studies have supported the concept that nocturnal asthma is simply asthma that is quantitatively more severe and is therefore more
Physiologic Insights
Desjardin and colleagues12 evaluated the effect of sleep on pulmonary capillary blood volume (measured by CO diffusion) in healthy control subjects, subjects with nocturnal asthma, and subjects with asthma and no nocturnal worsening. No significant differences in awake physiology were seen between the two groups of asthmatic subjects. Only in subjects with nocturnal asthma were changes in capillary blood volume seen (ie, a 15% increase). The mechanism of this effect was not established, but the
Treatment of Nocturnal Asthma
According to current US guidelines,1 nocturnal symptoms of asthma occurring more often than once weekly may indicate inadequate control of asthma. Because most patients with nocturnal asthma have symptoms at least this frequently, it follows that most patients with nocturnal asthma have persistent asthma of moderate or severe levels of severity, as determined by the guidelines. Furthermore, the preferred treatment for persistent asthma of these levels of severity is inhaled corticosteroids.
Summary
Nighttime awakening is a common symptom in asthma patients, which are associated with asthma morbidity, increased asthma severity, and uncontrolled or undercontrolled disease. Nocturnal asthma remains an area of controversy on a number of fronts (Table 2). Considerable evidence has suggested that nighttime symptoms of asthma are associated with increased asthma severity, but several well-controlled studies have argued that nocturnal asthma may be a distinct entity. Whether or not nocturnal
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Sleep Deficiency, Sleep Apnea, and Chronic Lung Disease
2022, Clinics in Chest MedicineImpact of dosage timing of once-daily inhaled corticosteroids in asthma: A systematic review and meta-analysis
2018, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :These symptoms can lead to sleep disruption.9 Also, lung function shows a circadian rhythm, with lung functionality being lowest in the early morning.10 These factors suggest that evening dosing with ICSs would provide an improved benefit compared with morning dosing.
Overlap syndrome - Asthma and obstructive sleep apnea
2016, Revista Portuguesa de PneumologiaImpact of Other Respiratory Conditions and Disorders During Sleep
2013, Encyclopedia of SleepImpact of Other Respiratory Conditions and Disorders During Sleep
2013, Encyclopedia of SleepEfficacy and Safety Profile of Fluticasone Furoate Administered Once Daily in the Morning or Evening: A Randomized, Double-Blind, Double-Dummy, Placebo-Controlled Trial in Adult and Adolescent Patients With Persistent Bronchial Asthma
2012, Clinical TherapeuticsCitation Excerpt :Asthma symptoms such as cough and dyspnea can be worse at night and early morning, leading to sleep disruption.1,6 In addition, lung function follows a circadian rhythm, with lung functionality being lowest in the early morning.7 Previous studies of time of dosing of once-daily ICS have suggested evening dosing to be similarly effective in relieving symptoms in asthma to morning dosing.8–10
This research was supported in part by grants HL-69130, HL/AI-63738.