Nocturnal asthma medical therapy

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Nocturnal asthma Microchapters


Patient Information




Differentiating Nocturnal Asthma from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings

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Other Imaging Findings

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Medical Therapy

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Secondary Prevention

Cost-Effectiveness of Therapy

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]

Medical Therapy

Indirect Therapy

  • Overnight nasal continuous positive airway pressure (nCPAP) abolishes nocturnal oxygen desaturation and offers improvement in nocturnal asthma control.[1][2][3]
  • Gastroesophageal reflux contributes little to the nocturnal worsening of asthma[4][5][6] 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.[7]

Direct Pharmacological Therapy


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  2. 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
  3. Martin RJ, Pak J (1991) Nasal CPAP in nonapneic nocturnal asthma. Chest 100 (4):1024-7. PMID: 1914551
  4. 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
  5. 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
  6. 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
  7. Weiner P, Azgad Y, Ganam R, Weiner M (1992) Inspiratory muscle training in patients with bronchial asthma. Chest 102 (5):1357-61. PMID: 1424851
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. Reinberg A, Halberg F, Falliers CJ (1974) Circadian timing of methylprednisolone effects in asthmatic boys. Chronobiologia 1 (4):333-47. PMID: 4468878
  23. 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
  24. 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
  25. Horn CR, Clark TJ, Cochrane GM (1984) Inhaled therapy reduces morning dips in asthma. Lancet 1 (8387):1143-5. PMID: 6144875
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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

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