Question: How Is Nocturnal Asthma Treated?
Answer:
Most patients with nocturnal asthma meet criteria as moderate or severe persistent asthma according to the National Heart, Lung, and Blood Institute asthma guidelines. You should be being treated according to these guidelines, but you and your provider may want to consider some of the following points if you think you have nocturnal asthma:
- Inhaled glucocorticoids: In a study comparing 800 μg (4 puffs of an Azmacort inhaler) at 3 p.m. each day to the traditional dose of 1 puff 4 times per day, the 3 p.m. dosing worked as well as the 4 times per day. When the dosing was changed to either 8:30 a.m. or 5 p.m. for convenience, the once daily 5:30 p.m. dosing still did better than the 4 times per day dosing, but the early morning dosing did worse.
- Inhaled β2 adrenergic agonists: Long acting β2 agonists, similar to your rescue inhaler but lasts 6 or more hours like salmeterol, have been shown to improve lung function overnight, improve sleep quality and overall quality of life in nocturnal asthma.
- Oral β2 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.
- 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 symptoms. With this regimen, the theophylline levels decrease during the day and patients experience less side effects than with traditional dosing.
- Treatment of other conditions that worsen asthma: A number of other medical conditions like gastric reflux, sinus problems and obesity may worsen your asthma. If you are having nocturnal asthma symptoms, make sure that you are not at risk for these conditions.
Sources:
Sutherland ER. Nocturnal asthma. J Allergy Clin Immunol. 2005 Dec;116(6):1179-86.
Martin RJ. UpToDate. Nocturnal asthma. Accessed April 5, 2009.
