Nocturnal asthma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Epidemiology and Demographics
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.[1][2]
Treatment
Indirect Therapy
- Overnight nasal continuous positive airway pressure (nCPAP) abolishes nocturnal oxygen desaturation and offers improvement in nocturnal asthma control.[3][4][5]
- Gastroesophageal reflux contributes little to the nocturnal worsening of asthma[6][7][8] 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.
- 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.[9]
Direct Pharmacological Therapy
- Inhaled 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.[10][11][12][13]
- Similar bronchodilation and good symptomatic control of nocturnal asthma may be achieved by both oral beta2 agonists such as extended release albuterol tablet and inhaled long-acting bronchodilator such as inhaled salmeterol.[14][15]
- 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.[16][17][18][19][20][21] Among the drugs, inhaled salmeterol and 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.[22]
- 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.[23] Long-term administration of corticosteroids at 8 A.M. and 3 P.M. was found to be more effective to control asthma and enhance peak expiratory flow rate values.[24][25][26]
- Inhalation method of administration of steroids, cromolyn and nedocromil has shown to be beneficial in reducing the morning dips and improving the mean peak expiratory flow rate value.[27][28][29][30]
- 5-lipoxygenase inhibitors such as zafirlukast and montelukast, have shown to significantly decrease the levels of LTB4 and improve FVE1 that is usually worsened in patients with nocturnal asthma.[31][32][33]
- 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.[34]
References
- ↑ Sutherland ER (2005) Nocturnal asthma: underlying mechanisms and treatment. Curr Allergy Asthma Rep 5 (2):161-7. PMID: 15683618
- ↑ Sutherland ER (2005) Nocturnal asthma. J Allergy Clin Immunol 116 (6):1179-86; quiz 1187. DOI:10.1016/j.jaci.2005.09.028 PMID: 16337443
- ↑ Chan CS, Woolcock AJ, Sullivan CE (1988) Nocturnal asthma: role of snoring and obstructive sleep apnea. Am Rev Respir Dis 137 (6):1502-4. PMID: 3059864
- ↑ NADEL JA, WIDDICOMBE JG (1962) Reflex effects of upper airway irritation on total lung resistance and blood pressure. J Appl Physiol 17 ():861-5. PMID: 13937041
- ↑ Martin RJ, Pak J (1991) Nasal CPAP in nonapneic nocturnal asthma. Chest 100 (4):1024-7. PMID: 1914551
- ↑ Tan WC, Martin RJ, Pandey R, Ballard RD (1990) Effects of spontaneous and simulated gastroesophageal reflux on sleeping asthmatics. Am Rev Respir Dis 141 (6):1394-9. PMID: 2350084
- ↑ Ford GA, Oliver PS, Prior JS, Butland RJ, Wilkinson SP (1994) 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: 8016006
- ↑ Harding SM, Schan CA, Guzzo MR, Alexander RW, Bradley LA, Richter JE (1995) Gastroesophageal reflux-induced bronchoconstriction. Is microaspiration a factor? Chest 108 (5):1220-7. PMID: 7587420
- ↑ Weiner P, Azgad Y, Ganam R, Weiner M (1992) Inspiratory muscle training in patients with bronchial asthma. Chest 102 (5):1357-61. PMID: 1424851
- ↑ Fitzpatrick MF, Mackay T, Driver H, Douglas NJ (1990) Salmeterol in nocturnal asthma: a double blind, placebo controlled trial of a long acting inhaled beta 2 agonist. BMJ 301 (6765):1365-8. PMID: 1980220
- ↑ Dahl R, Earnshaw JS, Palmer JB (1991) 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: 1687131
- ↑ Holimon TD, Chafin CC, Self TH (2001) Nocturnal asthma uncontrolled by inhaled corticosteroids: theophylline or long-acting beta2 agonists? Drugs 61 (3):391-418. PMID: 11293649
- ↑ Lockey RF, DuBuske LM, Friedman B, Petrocella V, Cox F, Rickard K (1999) Nocturnal asthma: effect of salmeterol on quality of life and clinical outcomes. Chest 115 (3):666-73. PMID: 10084473
- ↑ Crompton GK, Ayres JG, Basran G, Schiraldi G, Brusasco V, Eivindson A et al. (1999) 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: 10051257
- ↑ Martin RJ, Kraft M, Beaucher WN, Kiechel F, Sublett JL, LaVallee N et al. (1999) 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. DOI:10.1016/S1081-1206(10)62622-1 PMID: 10480584
- ↑ Kraft M, Torvik JA, Trudeau JB, Wenzel SE, Martin RJ (1996) Theophylline: potential antiinflammatory effects in nocturnal asthma. J Allergy Clin Immunol 97 (6):1242-6. PMID: 8648019
- ↑ D'Alonzo GE, Smolensky MH, Feldman S, Gianotti LA, Emerson MB, Staudinger H et al. (1990) 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: 2195936
- ↑ Martin RJ, Cicutto LC, Ballard RD, Goldenheim PD, Cherniack RM (1989) Circadian variations in theophylline concentrations and the treatment of nocturnal asthma. Am Rev Respir Dis 139 (2):475-8. PMID: 2913892
- ↑ Welsh PW, Reed CE, Conrad E (1986) 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: 3728507
- ↑ Smolensky MH, Scott PH, Kramer WG (1986) 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: 3771961
- ↑ Scott PH, Tabachnik E, MacLeod S, Correia J, Newth C, Levison H (1981) Sustained-release theophylline for childhood asthma: evidence for circadian variation of theophylline pharmacokinetics. J Pediatr 99 (3):476-9. PMID: 7264813
- ↑ Selby C, Engleman HM, Fitzpatrick MF, Sime PM, Mackay TW, Douglas NJ (1997) Inhaled salmeterol or oral theophylline in nocturnal asthma? Am J Respir Crit Care Med 155 (1):104-8. PMID: 9001297
- ↑ Beam WR, Weiner DE, Martin RJ (1992) Timing of prednisone and alterations of airways inflammation in nocturnal asthma. Am Rev Respir Dis 146 (6):1524-30. PMID: 1456570
- ↑ Reinberg A, Halberg F, Falliers CJ (1974) Circadian timing of methylprednisolone effects in asthmatic boys. Chronobiologia 1 (4):333-47. PMID: 4468878
- ↑ Reinberg A, Gervais P, Chaussade M, Fraboulet G, Duburque B (1983) Circadian changes in effectiveness of corticosteroids in eight patients with allergic asthma. J Allergy Clin Immunol 71 (4):425-33. PMID: 6339595
- ↑ Reinberg A, Guillet P, Gervais P, Ghata J, Vignaud D, Abulker C (1977) 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: 614119
- ↑ Horn CR, Clark TJ, Cochrane GM (1984) Inhaled therapy reduces morning dips in asthma. Lancet 1 (8387):1143-5. PMID: 6144875
- ↑ Petty TL, Rollins DR, Christopher K, Good JT, Oakley R (1989) Cromolyn sodium is effective in adult chronic asthmatics. Am Rev Respir Dis 139 (3):694-701. PMID: 2493760
- ↑ Pincus DJ, Szefler SJ, Ackerson LM, Martin RJ (1995) Chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy. J Allergy Clin Immunol 95 (6):1172-8. PMID: 7797785
- ↑ Pincus DJ, Humeston TR, Martin RJ (1997) 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: 9438485
- ↑ Wenzel SE, Trudeau JB, Kaminsky DA, Cohn J, Martin RJ, Westcott JY (1995) Effect of 5-lipoxygenase inhibition on bronchoconstriction and airway inflammation in nocturnal asthma. Am J Respir Crit Care Med 152 (3):897-905. PMID: 7663802
- ↑ Spector SL, Smith LJ, Glass M (1994) 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: 8087328
- ↑ Malmstrom K, Rodriguez-Gomez G, Guerra J, Villaran C, Piñeiro A, Wei LX et al. (1999) 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: 10075616
- ↑ Morrison JF, Pearson SB, Dean HG (1988) Parasympathetic nervous system in nocturnal asthma. Br Med J (Clin Res Ed) 296 (6634):1427-9. PMID: 3132275