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| {{Asthma}} | | '''For patient information, click [[Asthma (patient information)|here]]''' |
| {{CMG}}; {{AOEIC}} {{LG}} | | {{Nocturnal asthma}} |
| | {{CMG}}; {{AE}} {{LG}} |
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| ==Overview== | | ==[[Nocturnal asthma overview|Overview]]== |
| Nocturnal asthma is defined by a drop in [[FEV1|forced expiratory volume in 1 second (FEV1)]] of at least 15% between bedtime and awakening in patients with clinical and physiologic evidence of [[asthma]].<ref name="pmid15683618">Sutherland ER (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15683618 Nocturnal asthma: underlying mechanisms and treatment.] ''Curr Allergy Asthma Rep'' 5 (2):161-7. PMID: [http://pubmed.gov/15683618 15683618]</ref> The pathophysiology of nocturnal asthma is closely associated with the chronobiology and the science of biologic processes that have time-related rhythms. Hence, understanding the circadian rhythm is important to interpret the changes in pulmonary function that occurs in sleeping asthmatics. A large population based study reported dyspneic episodes without therapy in asthmatics occurred between 10 P.M. and 7 A.M.<ref name="pmid8494197">Martin RJ (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8494197 Nocturnal asthma: circadian rhythms and therapeutic interventions.] ''Am Rev Respir Dis'' 147 (6 Pt 2):S25-8. PMID: [http://pubmed.gov/8494197 8494197]</ref> Another population based survey that assessed 7729 patients, reported approximate 74% patients woke-up at least once a week with symptoms, 64% woke-up three times per week and 39% patients woke-up every night with symptoms.<ref name="pmid3400687">Turner-Warwick M (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3400687 Epidemiology of nocturnal asthma.] ''Am J Med'' 85 (1B):6-8. PMID: [http://pubmed.gov/3400687 3400687]</ref>
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| ==Epidemiology and Demographics== | | ==[[Nocturnal asthma pathophysiology|Pathophysiology]]== |
| * Nocturnal worsening of asthma is very common clinical finding in asthmatics affecting approximately 75% of asthmatics who awaken at least once per week because of symptoms, and approximately 40% experience nocturnal symptoms on a nightly basis.<ref name="pmid15683618">Sutherland ER (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15683618 Nocturnal asthma: underlying mechanisms and treatment.] ''Curr Allergy Asthma Rep'' 5 (2):161-7. PMID: [http://pubmed.gov/15683618 15683618]</ref><ref name="pmid16337443">Sutherland ER (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16337443 Nocturnal asthma.] ''J Allergy Clin Immunol'' 116 (6):1179-86; quiz 1187. [http://dx.doi.org/10.1016/j.jaci.2005.09.028 DOI:10.1016/j.jaci.2005.09.028] PMID: [http://pubmed.gov/16337443 16337443]</ref>
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| ==Pathophysiology== | | ==[[Nocturnal asthma causes|Causes]]== |
| The pathophysiology of nocturnal asthma is closely associated with the chronobiology and the science of biologic processes that have time-related rhythms.
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| *Alterations in [[Beta-adrenergic agonist|beta2-adrenergic]] <ref name="pmid15867853">Contopoulos-Ioannidis DG, Manoli EN, Ioannidis JP (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15867853 Meta-analysis of the association of beta2-adrenergic receptor polymorphisms with asthma phenotypes.] ''J Allergy Clin Immunol'' 115 (5):963-72. [http://dx.doi.org/10.1016/j.jaci.2004.12.1119 DOI:10.1016/j.jaci.2004.12.1119] PMID: [http://pubmed.gov/15867853 15867853]</ref><ref name="pmid7706471">Turki J, Pak J, Green SA, Martin RJ, Liggett SB (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7706471 Genetic polymorphisms of the beta 2-adrenergic receptor in nocturnal and nonnocturnal asthma. Evidence that Gly16 correlates with the nocturnal phenotype.] ''J Clin Invest'' 95 (4):1635-41. [http://dx.doi.org/10.1172/JCI117838 DOI:10.1172/JCI117838] PMID: [http://pubmed.gov/7706471 7706471]</ref> and [[steroid|glucocorticoid]] receptors <ref name="pmid9893187">Kraft M, Vianna E, Martin RJ, Leung DY (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9893187 Nocturnal asthma is associated with reduced glucocorticoid receptor binding affinity and decreased steroid responsiveness at night.] ''J Allergy Clin Immunol'' 103 (1 Pt 1):66-71. PMID: [http://pubmed.gov/9893187 9893187]</ref> and [[HPA axis|hypothalamic-pituitary-adrenal axis]] function have shown to play a role in modulating the nocturnal asthma phenotype, and recent studies have suggested elevation and phase delay of peak serum [[melatonin]],<ref name="pmid13679809">Sutherland ER, Ellison MC, Kraft M, Martin RJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=13679809 Elevated serum melatonin is associated with the nocturnal worsening of asthma.] ''J Allergy Clin Immunol'' 112 (3):513-7. PMID: [http://pubmed.gov/13679809 13679809]</ref> a neurohormonal controller of circadian rhythms, to play an important role in the pathogenesis of nocturnal asthma.<ref name="pmid16337443">Sutherland ER (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16337443 Nocturnal asthma.] ''J Allergy Clin Immunol'' 116 (6):1179-86; quiz 1187. [http://dx.doi.org/10.1016/j.jaci.2005.09.028 DOI:10.1016/j.jaci.2005.09.028] PMID: [http://pubmed.gov/16337443 16337443]</ref><ref name="pmid12847479">Sutherland ER, Ellison MC, Kraft M, Martin RJ (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12847479 Altered pituitary-adrenal interaction in nocturnal asthma.] ''J Allergy Clin Immunol'' 112 (1):52-7. PMID: [http://pubmed.gov/12847479 12847479]</ref>
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| *The increased of [[Fibronectin|CD51]] at night, in patients with nocturnal asthma, may be related to increased airway inflammation and repair processes in response to injury.<ref name="pmid9768576">Kraft M, Striz I, Georges G, Umino T, Takigawa K, Rennard S et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9768576 Expression of epithelial markers in nocturnal asthma.] ''J Allergy Clin Immunol'' 102 (3):376-81. PMID: [http://pubmed.gov/9768576 9768576]</ref>
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| *Research has demonstrated that the greatest inflammation in nocturnal asthmatics occurs in the proximal alveolar tissue at 4 AM. Inflammatory mediators such as [[eosinophils]], [[macrophages]] and CD4+ lymphocytic infiltration, were shown to accumulate in the proximal alveolar tissue and contribute to the variation in lung function.<ref name="pmid8912772">Kraft M, Djukanovic R, Wilson S, Holgate ST, Martin RJ (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8912772 Alveolar tissue inflammation in asthma.] ''Am J Respir Crit Care Med'' 154 (5):1505-10. PMID: [http://pubmed.gov/8912772 8912772]</ref><ref name="pmid9872843">Kraft M, Martin RJ, Wilson S, Djukanovic R, Holgate ST (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9872843 Lymphocyte and eosinophil influx into alveolar tissue in nocturnal asthma.] ''Am J Respir Crit Care Med'' 159 (1):228-34. PMID: [http://pubmed.gov/9872843 9872843]</ref>
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| *The development of nocturnal airway obstruction in asthma has been associated with the enhanced production of oxygen radicals by air-space cells. Because oxygen radicals can cause airway injury and thus enhance [[bronchial obstruction]], it has been postulated that the release of these reactive compounds is causally associated with nocturnal asthma.<ref name="pmid1329592">Jarjour NN, Busse WW, Calhoun WJ (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1329592 Enhanced production of oxygen radicals in nocturnal asthma.] ''Am Rev Respir Dis'' 146 (4):905-11. PMID: [http://pubmed.gov/1329592 1329592]</ref><ref name="pmid1990952">Martin RJ, Cicutto LC, Smith HR, Ballard RD, Szefler SJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1990952 Airways inflammation in nocturnal asthma.] ''Am Rev Respir Dis'' 143 (2):351-7. PMID: [http://pubmed.gov/1990952 1990952]</ref><ref name="pmid8655891">Doi S, Murayama N, Inoue T, Takamatsu I, Kameda M, Omoto Y et al. (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8655891 CD4 T-lymphocyte activation is associated with peak expiratory flow variability in childhood asthma.] ''J Allergy Clin Immunol'' 97 (4):955-62. PMID: [http://pubmed.gov/8655891 8655891]</ref>
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| *Worsening of nocturnal asthma has been associated to the secondary increase in the levels of inflammatory mediators such as [[leukotrienes]], [[interleukins]], and [[histamine]].<ref name="pmid1329592">Jarjour NN, Busse WW, Calhoun WJ (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1329592 Enhanced production of oxygen radicals in nocturnal asthma.] ''Am Rev Respir Dis'' 146 (4):905-11. PMID: [http://pubmed.gov/1329592 1329592]</ref><ref name="pmid6247655">Barnes P, FitzGerald G, Brown M, Dollery C (1980) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6247655 Nocturnal asthma and changes in circulating epinephrine, histamine, and cortisol.] ''N Engl J Med'' 303 (5):263-7. [http://dx.doi.org/10.1056/NEJM198007313030506 DOI:10.1056/NEJM198007313030506] PMID: [http://pubmed.gov/6247655 6247655]</ref><ref name="pmid7663802">Wenzel SE, Trudeau JB, Kaminsky DA, Cohn J, Martin RJ, Westcott JY (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7663802 Effect of 5-lipoxygenase inhibition on bronchoconstriction and airway inflammation in nocturnal asthma.] ''Am J Respir Crit Care Med'' 152 (3):897-905. PMID: [http://pubmed.gov/7663802 7663802]</ref><ref name="pmid7582279">Jarjour NN, Busse WW (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7582279 Cytokines in bronchoalveolar lavage fluid of patients with nocturnal asthma.] ''Am J Respir Crit Care Med'' 152 (5 Pt 1):1474-7. PMID: [http://pubmed.gov/7582279 7582279]</ref><ref name="pmid1846332">Szefler SJ, Ando R, Cicutto LC, Surs W, Hill MR, Martin RJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1846332 Plasma histamine, epinephrine, cortisol, and leukocyte beta-adrenergic receptors in nocturnal asthma.] ''Clin Pharmacol Ther'' 49 (1):59-68. PMID: [http://pubmed.gov/1846332 1846332]</ref><ref name="pmid8613628">Bellia V, Bonanno A, Cibella F, Cuttitta G, Mirabella A, Profita M et al. (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8613628 Urinary leukotriene E4 in the assessment of nocturnal asthma.] ''J Allergy Clin Immunol'' 97 (3):735-41. PMID: [http://pubmed.gov/8613628 8613628]</ref>
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| *Enhanced parasympathetic activity is associated with bronchial hyper-reactivity, which is characteristic of asthma. It is believed this increased cholinergic tone may be related to the pathogenesis of bronchial asthma.<ref name="pmid3132275">Morrison JF, Pearson SB, Dean HG (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3132275 Parasympathetic nervous system in nocturnal asthma.] ''Br Med J (Clin Res Ed)'' 296 (6634):1427-9. PMID: [http://pubmed.gov/3132275 3132275]</ref><ref name="pmid3987376">Kallenbach JM, Webster T, Dowdeswell R, Reinach SG, Millar RN, Zwi S (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3987376 Reflex heart rate control in asthma. Evidence of parasympathetic overactivity.] ''Chest'' 87 (5):644-8. PMID: [http://pubmed.gov/3987376 3987376]</ref>
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| ====Asthma and Obstructive Sleep Apnea==== | | ==[[Nocturnal asthma differential diagnosis|Differentiating Nocturnal Asthma from other Diseases]]== |
| *It is recognized with increasing frequency, that patients who have both [[obstructive sleep apnea]] and [[bronchial asthma]], often improve tremendously when the sleep apnea is diagnosed and treated.<ref name=sleep_anpea1>{{cite press release | title = Breathing disorders during sleep are common among asthmatics, may help predict severe asthma | publisher = University of Michigan Health System | date = May 25, 2005 | url = http://www.med.umich.edu/opm/newspage/2005/asthmasleep.htm }}</ref><ref name="pmid18849401">Teodorescu M, Consens FB, Bria WF, Coffey MJ, McMorris MS, Weatherwax KJ et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18849401 Predictors of habitual snoring and obstructive sleep apnea risk in patients with asthma.] ''Chest'' 135 (5):1125-32. [http://dx.doi.org/10.1378/chest.08-1273 DOI:10.1378/chest.08-1273] PMID: [http://pubmed.gov/18849401 18849401]</ref>
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| * However, [[CPAP]] has not shown to be effective in patients with nocturnal asthma alone.<ref name=CPAP_not_an_anti-asthmatic>{{cite web | url = http://www.sleepapnea.org/resources/pubs/asthma-osa.html | title = Asthma and OSA | accessmonthday = September 23 | accessyear = 2006 | last = Basner | first = Robert C. | work = ASAA Resources > Publications | publisher = American Sleep Apnea Association}}</ref>
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| ==Treatment== | | ==[[Nocturnal asthma epidemiology and demographics|Epidemiology and Demographics]]== |
| ====Indirect Therapy====
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| *Overnight nasal [[Positive airway pressure|continuous positive airway pressure]] (nCPAP) abolishes nocturnal oxygen desaturation and offers improvement in nocturnal asthma control.<ref name="pmid3059864">Chan CS, Woolcock AJ, Sullivan CE (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3059864 Nocturnal asthma: role of snoring and obstructive sleep apnea.] ''Am Rev Respir Dis'' 137 (6):1502-4. PMID: [http://pubmed.gov/3059864 3059864]</ref><ref name="pmid13937041">NADEL JA, WIDDICOMBE JG (1962) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=13937041 Reflex effects of upper airway irritation on total lung resistance and blood pressure.] ''J Appl Physiol'' 17 ():861-5. PMID: [http://pubmed.gov/13937041 13937041]</ref><ref name="pmid1914551">Martin RJ, Pak J (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1914551 Nasal CPAP in nonapneic nocturnal asthma.] ''Chest'' 100 (4):1024-7. PMID: [http://pubmed.gov/1914551 1914551]</ref>
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| *[[Asthma and gastroesophageal reflux|Gastroesophageal reflux]] contributes little to the nocturnal worsening of asthma <ref name="pmid2350084">Tan WC, Martin RJ, Pandey R, Ballard RD (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2350084 Effects of spontaneous and simulated gastroesophageal reflux on sleeping asthmatics.] ''Am Rev Respir Dis'' 141 (6):1394-9. PMID: [http://pubmed.gov/2350084 2350084]</ref><ref name="pmid8016006">Ford GA, Oliver PS, Prior JS, Butland RJ, Wilkinson SP (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8016006 Omeprazole in the treatment of asthmatics with nocturnal symptoms and gastro-oesophageal reflux: a placebo-controlled cross-over study.] ''Postgrad Med J'' 70 (823):350-4. PMID: [http://pubmed.gov/8016006 8016006]</ref><ref name="pmid7587420">Harding SM, Schan CA, Guzzo MR, Alexander RW, Bradley LA, Richter JE (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7587420 Gastroesophageal reflux-induced bronchoconstriction. Is microaspiration a factor?] ''Chest'' 108 (5):1220-7. PMID: [http://pubmed.gov/7587420 7587420]</ref> and hence, should be based upon symptoms of reflux and not based upon the worsening of asthma. However, if a patient complained of metallic taste in the mouth or unexplained infiltrates on chest x-ray, the possibility of reflux with aspiration should be considered.
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| *Specific inspiratory muscle training improves the inspiratory muscle strength and endurance. This can result in the improvement of asthmatic symptoms and medication consumption by asthmatics.<ref name="pmid1424851">Weiner P, Azgad Y, Ganam R, Weiner M (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1424851 Inspiratory muscle training in patients with bronchial asthma.] ''Chest'' 102 (5):1357-61. PMID: [http://pubmed.gov/1424851 1424851]</ref>
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| ====Direct Pharmacological Therapy==== | | ==[[Nocturnal asthma risk factors|Risk Factors]]== |
| *'''Inhaled [[Bronchodilator#Long-acting β2-agonists|long-acting bronchodilator]]''' such as [[salmeterol]] has shown to improve sleep quality and may be beneficial for patients who remain symptomatic despite anti-inflammatory therapy and environmental control.<ref name="pmid1980220">Fitzpatrick MF, Mackay T, Driver H, Douglas NJ (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1980220 Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist.] ''BMJ'' 301 (6765):1365-8. PMID: [http://pubmed.gov/1980220 1980220]</ref><ref name="pmid1687131">Dahl R, Earnshaw JS, Palmer JB (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1687131 Salmeterol: a four week study of a long-acting beta-adrenoceptor agonist for the treatment of reversible airways disease.] ''Eur Respir J'' 4 (10):1178-84. PMID: [http://pubmed.gov/1687131 1687131]</ref><ref name="pmid11293649">Holimon TD, Chafin CC, Self TH (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11293649 Nocturnal asthma uncontrolled by inhaled corticosteroids: theophylline or long-acting beta2 agonists?] ''Drugs'' 61 (3):391-418. PMID: [http://pubmed.gov/11293649 11293649]</ref><ref name="pmid10084473">Lockey RF, DuBuske LM, Friedman B, Petrocella V, Cox F, Rickard K (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10084473 Nocturnal asthma: effect of salmeterol on quality of life and clinical outcomes.] ''Chest'' 115 (3):666-73. PMID: [http://pubmed.gov/10084473 10084473]</ref>
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| *Similar bronchodilation and good symptomatic control of nocturnal asthma may be achieved by both '''[[Beta2-adrenergic receptor agonist|oral beta2 agonists]]''' such as extended release [[albuterol]] tablet and inhaled [[Bronchodilator#Long-acting β2-agonists|long-acting bronchodilator]] such as inhaled [[salmeterol]].<ref name="pmid10051257">Crompton GK, Ayres JG, Basran G, Schiraldi G, Brusasco V, Eivindson A et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10051257 Comparison of oral bambuterol and inhaled salmeterol in patients with symptomatic asthma and using inhaled corticosteroids.] ''Am J Respir Crit Care Med'' 159 (3):824-8. PMID: [http://pubmed.gov/10051257 10051257]</ref><ref name="pmid10480584">Martin RJ, Kraft M, Beaucher WN, Kiechel F, Sublett JL, LaVallee N et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10480584 Comparative study of extended release albuterol sulfate and long-acting inhaled salmeterol xinafoate in the treatment of nocturnal asthma.] ''Ann Allergy Asthma Immunol'' 83 (2):121-6. [http://dx.doi.org/10.1016/S1081-1206(10)62622-1 DOI:10.1016/S1081-1206(10)62622-1] PMID: [http://pubmed.gov/10480584 10480584]</ref>
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| *'''Sustained-release [[theophylline]]''' preparations alter the inflammatory cell number and function secondary to the leukotriene B4-mediated mechanism. Research has demonstrated this can provide better bronchial airflow levels overnight and stabilize nocturnal pulmonary function.<ref name="pmid8648019">Kraft M, Torvik JA, Trudeau JB, Wenzel SE, Martin RJ (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8648019 Theophylline: potential antiinflammatory effects in nocturnal asthma.] ''J Allergy Clin Immunol'' 97 (6):1242-6. PMID: [http://pubmed.gov/8648019 8648019]</ref><ref name="pmid2195936">D'Alonzo GE, Smolensky MH, Feldman S, Gianotti LA, Emerson MB, Staudinger H et al. (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2195936 Twenty-four hour lung function in adult patients with asthma. Chronoptimized theophylline therapy once-daily dosing in the evening versus conventional twice-daily dosing.] ''Am Rev Respir Dis'' 142 (1):84-90. PMID: [http://pubmed.gov/2195936 2195936]</ref><ref name="pmid2913892">Martin RJ, Cicutto LC, Ballard RD, Goldenheim PD, Cherniack RM (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2913892 Circadian variations in theophylline concentrations and the treatment of nocturnal asthma.] ''Am Rev Respir Dis'' 139 (2):475-8. PMID: [http://pubmed.gov/2913892 2913892]</ref><ref name="pmid3728507">Welsh PW, Reed CE, Conrad E (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3728507 Timing of once-a-day theophylline dose to match peak blood level with diurnal variation in severity of asthma.] ''Am J Med'' 80 (6):1098-102. PMID: [http://pubmed.gov/3728507 3728507]</ref><ref name="pmid3771961">Smolensky MH, Scott PH, Kramer WG (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3771961 Clinical significance of day-night differences in serum theophylline concentration with special reference to Theo-Dur.] ''J Allergy Clin Immunol'' 78 (4 Pt 2):716-22. PMID: [http://pubmed.gov/3771961 3771961]</ref><ref name="pmid7264813">Scott PH, Tabachnik E, MacLeod S, Correia J, Newth C, Levison H (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7264813 Sustained-release theophylline for childhood asthma: evidence for circadian variation of theophylline pharmacokinetics.] ''J Pediatr'' 99 (3):476-9. PMID: [http://pubmed.gov/7264813 7264813]</ref> Among the drugs, [[salmeterol|inhaled salmeterol]] and [[theophylline|oral theophylline]], only a small benefit in sleep quality, quality of life, and daytime cognitive function was observed with [[salmeterol]]; however, no major clinical advantage was noted.<ref name="pmid9001297">Selby C, Engleman HM, Fitzpatrick MF, Sime PM, Mackay TW, Douglas NJ (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9001297 Inhaled salmeterol or oral theophylline in nocturnal asthma?] ''Am J Respir Crit Care Med'' 155 (1):104-8. PMID: [http://pubmed.gov/9001297 9001297]</ref>
| | ==[[Nocturnal asthma natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *In patients with nocturnal asthma, the timing and dose of steroid alters both the inflammatory milieu and spirometric decline that is associated with nocturnal worsening of asthma.<ref name="pmid1456570">Beam WR, Weiner DE, Martin RJ (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1456570 Timing of prednisone and alterations of airways inflammation in nocturnal asthma.] ''Am Rev Respir Dis'' 146 (6):1524-30. PMID: [http://pubmed.gov/1456570 1456570]</ref> Long-term administration of '''[[corticosteroids]]''' at 8 A.M. and 3 P.M. was found to be more effective to control asthma and enhance [[Asthma pulmonary function test#Peak Expiratory Flow Rate|peak expiratory flow rate values]].<ref name="pmid4468878">Reinberg A, Halberg F, Falliers CJ (1974) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4468878 Circadian timing of methylprednisolone effects in asthmatic boys.] ''Chronobiologia'' 1 (4):333-47. PMID: [http://pubmed.gov/4468878 4468878]</ref><ref name="pmid6339595">Reinberg A, Gervais P, Chaussade M, Fraboulet G, Duburque B (1983) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6339595 Circadian changes in effectiveness of corticosteroids in eight patients with allergic asthma.] ''J Allergy Clin Immunol'' 71 (4):425-33. PMID: [http://pubmed.gov/6339595 6339595]</ref><ref name="pmid614119">Reinberg A, Guillet P, Gervais P, Ghata J, Vignaud D, Abulker C (1977) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=614119 One month chronocorticotherapy (Dutimelan 8 15 mite). Control of the asthmatic condition without adrenal suppression and circadian rhythm alteration.] ''Chronobiologia'' 4 (4):295-312. PMID: [http://pubmed.gov/614119 614119]</ref>
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| *'''Inhalation method''' of administration of [[steroids]], [[cromolyn]] and [[nedocromil]] has shown to be beneficial in reducing the morning dips and improving the mean [[Asthma pulmonary function test#Peak Expiratory Flow Rate|peak expiratory flow rate value]].<ref name="pmid6144875">Horn CR, Clark TJ, Cochrane GM (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6144875 Inhaled therapy reduces morning dips in asthma.] ''Lancet'' 1 (8387):1143-5. PMID: [http://pubmed.gov/6144875 6144875]</ref><ref name="pmid2493760">Petty TL, Rollins DR, Christopher K, Good JT, Oakley R (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2493760 Cromolyn sodium is effective in adult chronic asthmatics.] ''Am Rev Respir Dis'' 139 (3):694-701. PMID: [http://pubmed.gov/2493760 2493760]</ref><ref name="pmid7797785">Pincus DJ, Szefler SJ, Ackerson LM, Martin RJ (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7797785 Chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy.] ''J Allergy Clin Immunol'' 95 (6):1172-8. PMID: [http://pubmed.gov/7797785 7797785]</ref><ref name="pmid9438485">Pincus DJ, Humeston TR, Martin RJ (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9438485 Further studies on the chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy.] ''J Allergy Clin Immunol'' 100 (6 Pt 1):771-4. PMID: [http://pubmed.gov/9438485 9438485]</ref>
| | ==Diagnosis== |
| | [[Nocturnal asthma history and symptoms|History and Symptoms]] | [[Nocturnal asthma physical examination|Physical Examination]] | [[Nocturnal asthma laboratory findings|Laboratory Findings]] | [[Nocturnal asthma chest x ray|Chest X Ray]] | [[Nocturnal asthma CT|CT]] | [[Nocturnal asthma other imaging findings|Other Imaging Findings]] | [[Nocturnal asthma other diagnostic studies|Other Diagnostic Studies]] |
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| *'''[[Lipoxygenase inhibitor|5-lipoxygenase inhibitors]]''' such as [[zafirlukast]] and [[montelukast]], have shown to significantly decrease the levels of [[Leukotriene A4|LTB4]] and improve [[FVE1]] that is usually worsened in patients with nocturnal asthma.<ref name="pmid7663802">Wenzel SE, Trudeau JB, Kaminsky DA, Cohn J, Martin RJ, Westcott JY (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7663802 Effect of 5-lipoxygenase inhibition on bronchoconstriction and airway inflammation in nocturnal asthma.] ''Am J Respir Crit Care Med'' 152 (3):897-905. PMID: [http://pubmed.gov/7663802 7663802]</ref><ref name="pmid8087328">Spector SL, Smith LJ, Glass M (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8087328 Effects of 6 weeks of therapy with oral doses of ICI 204,219, a leukotriene D4 receptor antagonist, in subjects with bronchial asthma. ACCOLATE Asthma Trialists Group.] ''Am J Respir Crit Care Med'' 150 (3):618-23. PMID: [http://pubmed.gov/8087328 8087328]</ref><ref name="pmid10075616">Malmstrom K, Rodriguez-Gomez G, Guerra J, Villaran C, Piñeiro A, Wei LX et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10075616 Oral montelukast, inhaled beclomethasone, and placebo for chronic asthma. A randomized, controlled trial. Montelukast/Beclomethasone Study Group.] ''Ann Intern Med'' 130 (6):487-95. PMID: [http://pubmed.gov/10075616 10075616]</ref>
| | ==Treatment== |
| | [[Nocturnal asthma medical therapy|Medical Therapy]] | [[Nocturnal asthma primary prevention|Primary Prevention]] | [[Nocturnal asthma secondary prevention|Secondary Prevention]] | [[Nocturnal asthma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Nocturnal asthma future or investigational therapies|Future or Investigational Therapies]] |
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| *Inhaled short-acting anticholinergic drugs, that affect vagal blockade have shown to provide little benefit on the overnight fall in pulmonary function seen in patients with nocturnal asthma.<ref name="pmid3132275">Morrison JF, Pearson SB, Dean HG (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3132275 Parasympathetic nervous system in nocturnal asthma.] ''Br Med J (Clin Res Ed)'' 296 (6634):1427-9. PMID: [http://pubmed.gov/3132275 3132275]</ref>
| | ==Case Studies== |
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| ==References== | | [[Nocturnal asthma case study one|Case #1]] |
| {{reflist|2}} | | ==Related Chapters== |
| | *[[Asthma]] |
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