Nocturnal asthma: Difference between revisions

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{{Nocturnal asthma}}
{{Nocturnal asthma}}
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==Pathophysiology==
The pathophysiology of nocturnal asthma is closely associated with the chronobiology and the science of biologic processes that have time-related rhythms.
*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>
*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>
*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>
*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>
*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>
*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>
====Asthma and Obstructive Sleep Apnea====
*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>
* 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>


==Epidemiology and Demographics==
==Epidemiology and Demographics==

Revision as of 15:45, 5 March 2013

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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

References

  1. ↑ Sutherland ER (2005) Nocturnal asthma: underlying mechanisms and treatment. Curr Allergy Asthma Rep 5 (2):161-7. PMID: 15683618
  2. ↑ 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
  3. ↑ 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
  4. ↑ 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
  5. ↑ Martin RJ, Pak J (1991) Nasal CPAP in nonapneic nocturnal asthma. Chest 100 (4):1024-7. PMID: 1914551
  6. ↑ 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
  7. ↑ 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
  8. ↑ 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
  9. ↑ Weiner P, Azgad Y, Ganam R, Weiner M (1992) Inspiratory muscle training in patients with bronchial asthma. Chest 102 (5):1357-61. PMID: 1424851
  10. ↑ 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
  11. ↑ 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
  12. ↑ 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
  13. ↑ 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
  14. ↑ 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
  15. ↑ 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
  16. ↑ 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
  17. ↑ 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
  18. ↑ 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
  19. ↑ 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
  20. ↑ 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
  21. ↑ 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
  22. ↑ 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
  23. ↑ 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
  24. ↑ Reinberg A, Halberg F, Falliers CJ (1974) Circadian timing of methylprednisolone effects in asthmatic boys. Chronobiologia 1 (4):333-47. PMID: 4468878
  25. ↑ 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
  26. ↑ 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
  27. ↑ Horn CR, Clark TJ, Cochrane GM (1984) Inhaled therapy reduces morning dips in asthma. Lancet 1 (8387):1143-5. PMID: 6144875
  28. ↑ 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
  29. ↑ 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
  30. ↑ 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
  31. ↑ 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
  32. ↑ 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
  33. ↑ 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
  34. ↑ 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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