Asthma: diagnosis and management of nocturnal symptoms.
An approach to asthma evaluation and treatment that seriously considers the strong nocturnal predilection for exacerbations of asthma is necessary for proper care of most asthmatics. Appreciation of the chronopharmacology of medications that may improve nocturnal asthma is essential. Controlled-release theophylline preparations, such as Uniphyl, which achieve peak blood levels 10-12 hours after dosage, should be administered immediately after the evening meal to give greatest efficacy between 3 and 6 AM when airflow reaches its nadir. Oral corticosteroids should be administered around 3 PM to achieve peak pulmonary antiinflammatory efficacy between 3 AM and 6 AM corticosteroid-induced decreases in inflammatory cell infiltration in lungs clearly being associated with improvement in lung function. Future developments of high-potency inhaled corticosteroid medications or sustained-action inhaled anticholinergic agents may add to the therapeutic armamentarium in the battle against asthma, the nocturnal affliction.
DuBuske
L M
LM
Department of Allergy and Rheumatology, Harvard Medical School, Boston, Massachusetts.
D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002940:Circadian Rhythm; D003624:Darkness; D006801:Humans; D006967:Hypersensitivity / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D012123:Pulmonary Ventilation / Q000502:physiology; D012890:Sleep / Q000502:physiology; D014851:Wakefulness
D001993:Bronchodilator Agents