Nocturnal asthma and timing of treatment

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Abstract

Nocturnal deterioration of pulmonary function in asthmatic patients is a well-recognized and well-documented phenomenon. The mechanism of this “morning dip,” however, remains uncertain. Although the circadian rhythms of body temperature, corticosteroid, catecholamine, histamine, and opiate peptide levels, and even sleep itself have been shown to be in phase with the diurnal variation in asthma, a causal relationship has yet to be established. Increased nighttime bronchial reactivity to histamine, acetylcholine, and house dust allergen have been demonstrated. In general, continuous treatment with theophylline, beta-adrenergic agonists, or corticosteroids attenuates the degree of morning dip but does not completely eliminate the circadian rhythm of asthma. The significance of nocturnal asthma is emphasized by the observation that asthma deaths occur more frequently during nighttime hours and are often preceded by large daily swings in peak expiratory flow. Further studies examining the etiology and treatment of nocturnal asthma are needed.

References (34)

  • PJ Barnes et al.

    Single-dose slow-release aminophylline at night prevents nocturnal asthma

    Lancet

    (1982)
  • CR Horn et al.

    Inhaled therapy reduces morning dips in asthma

    Lancet

    (1984)
  • A Reinberg et al.

    Circadian changes in effectiveness of corticosteroids in eight patients with allergic asthma

    J Allergy Clin Immunol

    (1983)
  • MR Hetzel et al.

    Physiological patterns in early morning asthma

    Thorax

    (1977)
  • MR Hetzel et al.

    Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate

    Thorax

    (1980)
  • KD Dawkins et al.

    Diurnal variation in airflow obstruction in chronic bronchitis

    Thorax

    (1981)
  • JRM Bateman et al.

    Mucociliary clearance during sleep in healthy subjects

    Thorax

    (1977)
  • Cited by (0)

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