___________________________________________________________ Asthma: Diagnosis and Management
Nocturnal Asthma Asthma symptoms can be influenced by the time of the day. Often, asthma worsens at night, especially between 2:00 a.m. and 4:00 a.m., or in the early morning prior to or upon awaken- ing. Many patients with asthma awaken with a choking cough, wheezing, breathlessness, or chest tightness; symptoms may last a short period or may persist for minutes or hours. For patients with persistent nocturnal asthma, symptoms disrupt sleep and may affect ability to function normally during wak- ing hours. Nocturnal asthma not only leads to sleep loss but also usually indicates uncontrolled asthma [8; 13; 65]. There are many possible causes of nocturnal asthma. In sensitive individuals, increased amounts of dust mites and other allergens, such as fungal spores, embedded in bedding may trigger allergic asthma. This would, of course, only affect those patients with specific sensitivities. Levels of the hor- mones epinephrine and cortisol, which play an important role in keeping bronchial airways open, reach their lowest point between midnight and 6:00 a.m. Additionally, histamine levels, which may worsen asthma symptoms, peak at night. Reduced adrenal gland function at night may also be responsible for the decreased amounts of epinephrine and corticosteroids in the blood [8; 13; 65]. The cold night air may lower bronchial airway temperatures, inducing lumen constriction and triggering asthma symptoms. Furthermore, about half of individuals with asthma notice that their symptoms intensify 4 to 12 hours after the first reaction, suggesting that a nocturnal attack may result from a trigger encountered earlier in the day. Lastly, a reclining sleep posi- tion may increase the likelihood of gastric reflux symptoms, which may exacerbate or mimic an asthma episode [8; 13; 65].
CONCLUSION Asthma is one of the most common respiratory conditions affecting children, adolescents, and adults, and the number of individuals affected continues to grow each year. Diagnosis may be complex, especially in certain populations, but it is a vital key to providing the effective treatment and management of the disorder. Affected individuals’ signs and symptoms vary in severity, and treatment plans should be determined accord- ingly. Healthcare professionals should keep current with the latest treatments and medications as well as the latest studies and theories for asthma treatment and exacerbation prevention in order to provide the best patient-centered care.
RESOURCES
AIRNow https://airnow.gov American Lung Association https://www.lung.org Asthma and Allergy Foundation of America https://www.aafa.org Centers for Disease Control and Prevention https://www.cdc.gov/asthma National Heart Lung and Blood Institute Asthma Action Plan Template https://www.nhlbi.nih.gov/resources/asthma-action- plan-2020 National Institute of Allergy and Infectious Diseases https://www.niaid.nih.gov/diseases-conditions/asthma
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