Future treatment of nocturnal asthma will continue to be guided by increased understanding of circadian and sleep-related events. Understanding the kinetics of the different drug preparations is necessary for most effective timing of dose. Symptoms can be prevented by avoiding triggers, such as allergens and respiratory irritants, and. Chronopharmacology includes the strategic use of longer-acting beta-agonists, theophylline, corticosteroids, and anticholinergics. There is no known cure for asthma, but it can be controlled. The treatment of nocturnal asthma requires a chronopharmacologic approach, in which more intense therapy is targeted to coincide with the time that the disease is the worst. Circadian variation in pulmonary function, as well as the effect of therapeutic interventions, can be readily demonstrated by having patients record peak expiratory flow rate values at different times of the day and night, using a peak flow meter. Circadian changes in epinephrine, AMP, histamine and other inflammatory mediators, cortisol, vagal tone, body temperature, and lower airway secretions are potential mechanisms that favor nocturnal bronchoconstriction. Nocturnal asthma can be seen as representing an exaggerated amplitude of normal circadian patterns, including increased airway responsiveness and decreased lung function at night and in the early morning. Click to see any corrections or updates and to confirm this is the authentic version of record. American Journal of Respiratory and Critical Care Medicine. The 24-h cycle (circadian rhythm) is especially important in understanding the changes in pulmonary function that occur in sleeping asthmatics. Fluticasone propionate, salmeterol xinafoate, and their combination in the treatment of nocturnal asthma. The new direction in treating asthma will be orally administered medication that has few side effects and is targeted specifically to the pathogenesis of asthma.The pathophysiology of nocturnal asthma is closely associated with chronobiology, the science of biologic processes that have time-related rhythms. These drugs have virtually no side effects, and their onset is slower and their action longer than inhaled beta 2-agonists. The anticholinergic bronchodilators are more useful for treating COPD than for chronic asthma. Cromones work best for patients who have mild asthma: they have few adverse effects, but their activity is brief, so they must be given four times daily. Although theophylline is inexpensive, monitoring its plasma concentrations is both expensive and inconvenient. Theophylline is a bronchodilator that is useful for severe and nocturnal asthma, but recent studies suggest that it may also have an immunomodulatory effect. Reducing the burden of allergen exposure by keeping the bedroom free of dust may help. Important treatment considerations for nocturnal asthma are listed in Box 225, and general asthma guidelines (Step treatment) are listed in Table 227. Their side effects can be reduced by rinsing the mouth or by using large-volume spacers. Berry MD, in Fundamentals of Sleep Medicine, 2012. First-line therapy for chronic asthma is inhaled glucocorticoids, the only currently available agents that reduce airway inflammation. Short-acting forms give rapid relief long-acting agents provide sustained relief and help nocturnal asthma and serious adverse effects are rare when these drugs are used properly. For acute, severe asthma, the inhaled beta 2-agonists are the most effective bronchodilators. Drugs currently used to treat asthma include beta 2-agonists, glucocorticoids, theophylline, cromones, and anticholinergic agents. Many attempts have been made to refine rather than change therapy over the past 20 years. Effective treatments for asthma exist, but morbidity and mortality have continued to climb.
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