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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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| | ==[[Nocturnal asthma overview|Overview]]== |
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| | ==[[Nocturnal asthma pathophysiology|Pathophysiology]]== |
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| | ==[[Nocturnal asthma causes|Causes]]== |
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| | ==[[Nocturnal asthma differential diagnosis|Differentiating Nocturnal Asthma from other Diseases]]== |
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| | ==[[Nocturnal asthma epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[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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| ==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.
| | ==Case Studies== |
| *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== | | [[Nocturnal asthma case study one|Case #1]] |
| {{reflist|2}} | | ==Related Chapters== |
| | *[[Asthma]] |
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Overview complete]]
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| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Immunology]] | | [[Category:Immunology]] |
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| [[Category:Allergology]] | | [[Category:Allergology]] |
| [[Category:Asthma]] | | [[Category:Asthma]] |
| [[Category:Primary care]]
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| [[Category:Up-To-Date]] | | [[Category:Up-To-Date]] |
| [[Category:Up-To-Date pulmonology]] | | [[Category:Up-To-Date pulmonology]] |
| [[Category:Mature chapter]]
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