Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Nocturnal asthma medical therapy
Introduction
Medical Therapy
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
- 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.[8][9][10][11]
- 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.[12][13]
- 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.[14][15][16][17][18][19] 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.[20]
- 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.[21] 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.[22][23][24]
- 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.[25][26][27][28]
- 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.[29][30][31]
- 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.[32]
References
References
- ↑ 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
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]