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| __NOTOC__ | | __NOTOC__ |
| | '''For patient information, click [[Asthma (patient information)|here]]''' |
| {{Nocturnal asthma}} | | {{Nocturnal asthma}} |
| {{CMG}}; {{AE}} {{LG}} | | {{CMG}}; {{AE}} {{LG}} |
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| ==Pathophysiology== | | ==[[Nocturnal asthma overview|Overview]]== |
| 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>
| | ==[[Nocturnal asthma pathophysiology|Pathophysiology]]== |
| *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>
| | ==[[Nocturnal asthma causes|Causes]]== |
| *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>
| | ==[[Nocturnal asthma differential diagnosis|Differentiating Nocturnal Asthma from other Diseases]]== |
| *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 epidemiology and demographics|Epidemiology and Demographics]]== |
| *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>
| | ==[[Nocturnal asthma risk factors|Risk Factors]]== |
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| | ==[[Nocturnal asthma natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| | ==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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| ==Epidemiology and Demographics==
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| 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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| ==Treatment== | | ==Treatment== |
| ===Indirect Therapy===
| | [[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]] |
| *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===
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| *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>
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| *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>
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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>
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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>
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| ==References== | | ==Case Studies== |
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| | [[Nocturnal asthma case study one|Case #1]] |
| | ==Related Chapters== |
| | *[[Asthma]] |
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| [[Category:Asthma]] | | [[Category:Asthma]] |
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