title: Nocturnal asthma.
abstract: OBJECTIVE
  The aim is to review pathophysiological mechanisms and treatment of nocturnal asthma.
  
  
  RESULTS
  Physiologic changes accompanying sleep, as well as the nocturnal phase of circadian rhythms, may have an adverse effect on asthma control. Chronotherapeutic principles, which consider circadian variation in relevant biologic rhythms, may improve asthma outcomes. Administration of long-acting bronchodilators and inhaled corticosteroids which achieve maximum efficacy at night may improve nocturnal asthma. Comorbid conditions that may contribute to nocturnal asthma should be considered. The prevalence of obstructive sleep apnea is greater in a cohort of patients with severe asthma than in moderate asthma and in BMI and age matched nonasthmatic controls, suggesting a link between these diseases. A large trial concluded that esomeprazole did not improve asthma control even with comorbid acid reflux, questioning the importance of acid reflux in asthma. The role of polymorphisms of the β2-adrenergic receptor and their relationship with nocturnal asthma remain controversial.
  
  
  CONCLUSIONS
  Sleep is a time of vulnerability to respiratory compromise, especially in asthma patients experiencing nocturnal exacerbations. This asthma phenotype is associated with poorer control, reduced sleep quality, daytime somnolence and increased morbidity and mortality. Nocturnal asthma is a common but under-recognized problem.
authors: Division of Pulmonary, Critical Care and Sleep Medicine, The North Shore-LIJ Health System, Hofstra University School of Medicine, 410 Lakeville Road, New Hyde Park, NY 11042, USA.
authors: Harly
authors: H
authors: Greenberg
authors: Rubin I
authors: RI
authors: Cohen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D015992:Body Mass Index; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002940:Circadian Rhythm; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D020641:Polymorphism, Single Nucleotide; D018343:Receptors, Adrenergic, beta-2 / Q000235:genetics; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018343:Receptors, Adrenergic, beta-2