Dr.Kamini Silvarajan MD/AAAM

Editorial Board: Dr.Kamini Silvarajan MD/AAAM

Nocturnal Asthma

This article is a continuation from each description of the Types Of Asthma:

When you have Nocturnal Asthma (occurring, or active at night), your FEV1 (Forced Expiratory Volume in one second; the volume that a subject can exhale in the first second during a forced expiration test – esp.done by a spirometry – decreases by at least 15% from bedtime to getting up in the morning in patients with asthma. For some people, the decline in lung function can be significantly more and this is all associated with increased symptoms, such as cough, wheezing and shortness of breath that disrupt sleep. Patients with large nighttime changes in their FEV1 may also have more daytime symptoms.

Diagnosis Of Nocturnal Asthma

Diagnosing nocturnal asthma is by taking a bedtime peak flow and a peak flow when you wake up.If there is more than a 15% difference in your peak flow, you have significant variability that may be the cause of your symptoms. But, peak flow meters are not very sensitive to detect FEV1 changes. Therefore, your medical professionals may need to consider Therapeutic Trial ( – is when a doctor makes a diagnosis and starts treatment based on symptoms only, without other testings. For instance, a patient may be started on Albuterol if wheezing or Prilosec if one has gastroesophageal reflux or GERD symptoms).

Prevalent(common) Of Nocturnal Asthma

Research statistics of asthma have revealed that about 74% of asthmatics have nighttime awakenings at least one time per week, while as many as 64% may have asthma at night three or more times per week. Further research has given results as many as 40% asthmatics experience symptoms nightly.

Asthma patients may ignore nighttime symptoms cause of poor asthma control. Further studies has shown 26% of patients who rated their asthma as mild reported experiencing asthma symptoms like cough, wheezing, and shortness of breath nightly.

It is essential to recognize these nighttime symptoms as poor control, because a significant proportion of severe asthma in adults and children from respiratory arrest and sudden death occurs between midnight and eight in the morning.

Physiology (The way in which a living organism or bodily part functions) Of Nocturnal Asthma

Importantly,most of us does not know for sure that asthma at night has been associated with the following vital factors:-

  1. Decreased nitric oxide levels:- Because nitric oxide is a potent bronchodilator (a drug that causes widening of the bronchi, e.g., any of those taken by inhalation for the alleviation of asthma) – decreased levels could possibly explain the increased nighttime symptoms.
  2. Decreased Beta 2-receptors:-Both the number and function of Beta 2 receptors — the receptors that are responsible for the bronchodilation that opens up your airways decrease between four in the afternoon and four in the morning.
  3. Decreased steroid receptors:- Same as Beta 2 receptors, both the numbers and function of steroid receptors, responsible for decreasing inflammation, decline at night and may be responsible for the increased inflammation due to a lack of response to your bodies naturally produced steroids or steroids prescribed by your medical professionals.
  4. Abnormal pituitary* function (*the major endocrine gland. A pea-sized body attached to the base of the brain, the pituitary is important in controlling growth and development and the functioning of the other endocrine glands):- Cortisol, a hormone produced by the pituitary gland, production declines overnight and these reductions are associated with declines in FEV1. Among patients with low cortisol levels, treating patients with hydrocortisone, a therapeutic steroid given to patients when cortisol levels are low, is associated with improvements in FEV1.
  5. Melatonin (a hormone secreted by the pineal gland that inhibits melanin formation and is thought to be concerned with regulating the reproductive cycle): -Patients with nocturnal asthma have been noted to have low melatonin levels compared to patients without nocturnal asthma.
  6. Inhaled glucocorticoids: Under a study comparing 800 μg [(microgram) (4 puffs of an Azmacort inhaler)] at three in the afternoon each day to the traditional dose of 1 puff 4 times per day, the three in the afternoon dose worked as well as the 4 times per day. When the dosing was changed to either eight thirty in the morning or five in the evening for convenience, the once daily at five thirty in the evening dose still did better than the 4 times per day dosing, but the early morning dosing did worse.
  7. Inhaled beta2 adrenergic agonists: Long acting beta2 agonists, similar to your rescue inhaler but lasts six or more hours, like Salmeterol have been shown to improve lung function overnight, improve sleep quality and overall quality of life in nocturnal asthma.
  8. Oral beta2 adrenergic agonists: Oral forms of Albuterol given as a slow release pill increase morning peak expiratory flow rates and decrease wheezing and shortness of breath.
  9. Theophylline: Different types of theophylline have different properties. One that may particularly help nocturnal asthma is a preparation designed to have higher levels at night, like Uniphyl, when you are experiencing more asthma symptoms. With this prescribed course of medical treatment the theophylline levels decrease during the day and patients experience fewer side effects than with traditional dosing.
  10. Other asthma conditions:- Many other medical conditions like gastric reflux, sinus problems and obesity may worsen your asthma.Once you confirm that you have nocturnal asthma symptoms make sure that you are not at danger for these conditions.

Treating Nocturnal Asthma

Mostly patients with asthma at night meet criteria as moderate or severe persistent asthma according to the asthma guidelines.Asthmatics should be treated according to these guidelines, but you and your medical professionals may want to consider some of the following guidelines if you think you have nocturnal asthma: