Nocturnal asthma

Curr Opin Pulm Med. 2012 Jan;18(1):57-62. doi: 10.1097/MCP.0b013e32834d098e.


Purpose of review: The aim is to review pathophysiological mechanisms and treatment of nocturnal asthma.

Recent findings: 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.

Summary: 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.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy
  • Asthma / etiology*
  • Asthma / physiopathology
  • Body Mass Index
  • Bronchodilator Agents / therapeutic use
  • Circadian Rhythm
  • Cohort Studies
  • Continuous Positive Airway Pressure
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / physiopathology
  • Humans
  • Polymorphism, Single Nucleotide
  • Receptors, Adrenergic, beta-2 / genetics
  • Sleep Apnea, Obstructive / complications*
  • Sleep Apnea, Obstructive / drug therapy
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep*


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Bronchodilator Agents
  • Receptors, Adrenergic, beta-2