Nocturnal asthma - Therapeutic considerations

Nocturnal asthma is an important part of asthma and must be considered in regard to therapy. The majority of patients with asthma have nocturnal worsening in lung function. The aetiology of this process is multifactorial and interactive. There are many naturally occurring circadian rhythms, which for the normal individual have only a minor effect on lung function, However, in the asthmatic patient, these day to night alterations in circadian rhythm produce increased airway inflammation and worsening of asthma. Therapy should be approached from 2 viewpoints. First, there are indirect interventions which can improve nocturnal asthma. These include treatment of sleep apnoea, if it exists in an asthma patient, high-gastroesophageal reflux and rhinosinusitis, as well as inspiratory muscle training, The second treatment option focuses on direct pharmacological approaches using the new concept of chronotherapy. That is, instead of viewing a patient as being in homeostasis and administering medication in equally divided doses, treatment should be focused on delivering higher doses of medication at the time of day when the disease process is at its most severe.