What Is Nocturnal Asthma?

The 2014 GINA guidelines define asthma: Asthma is a heterogeneous disease, often characterized by chronic airway inflammation, and includes a history of respiratory symptoms that change over time, such as wheezing, shortness of breath, chest tightness, and cough, with variable expiration Restricted airflow. It is clinically found that the clinical characteristics of asthma and airway inflammation have different phenotypes. Nocturnal asthma is one of the clinical characteristics. Its importance is also that asthma-induced respiratory arrests occur at night. According to statistics, 70% of asthma deaths occur during sleep-related periods. At present, some progress has been made on the neural mechanisms, inflammatory mechanisms and their effects, consequences and treatments that cause nocturnal asthma.

Basic Information

English name

night asthma

Visiting department

Respiratory

Common causes

Associated with airway eosinophilic inflammation

Common symptoms

Wheezing, chest tightness, cough, itchy nose, sneezing, runny nose, itchy eyes and tears, etc.

Causes of nocturnal asthma

The pathogenesis of nocturnal asthma is basically the same as that of general asthma. It is also a disease characterized by chronic non-specific inflammation of the airways, which involves a variety of interacting inflammatory cells. Mast cells are the main cause of acute asthma. Effector cells act as a "trigger"; eosinophils are considered to be the main effector cells that induce airway inflammation in chronic asthma. It has been shown that the percentage and count of eosinophils is inversely related to FEV1. Recent foreign studies on nocturnal asthma have found that eosinophils in peripheral blood and sputum of patients with nocturnal asthma are significantly higher than those in normal people, indicating that the incidence of nocturnal asthma is closely related to airway eosinophilic inflammation.

Nocturnal asthma clinical manifestations

Gasp

The wheezing symptoms of asthma patients are paroxysmal wheezing, accompanied by wheezing, short inspiration, and relative expiration. The wheezing symptoms occur suddenly at night or in the early morning, and the short-lived person lasts for several minutes, and the elderly person lasts for several hours or even several days. It can be relieved naturally or after treatment.

Chest tightness

The patient has a sense of urgency on the chest and has trouble breathing. During an asthma attack, the patient feels that inhaling air is not enough, and even severely suffocates. Chest tightness can be present with or without wheezing.

3. cough

Asthma is usually irritating dry cough, but the cough is reduced during the attack, mainly wheezing, and the sputum tends to be relieved when the attack tends to be relieved. If there is no co-infection, it is usually colorless or white translucent sticky sputum. , Sometimes grainy or mucus columnar. In some patients, a large amount of colorless or white translucent foamy sputum can be coughed up when the attack or tends to be relieved. Cough can coexist with chest tightness and wheezing. It can also be the only symptom of asthma, such as cough variant asthma, which is characterized by dry cough or low sputum, and antibiotics are not effective. Patients are often missed or misdiagnosed.

4. Other

In addition to the above symptoms, asthma is often accompanied by other symptoms, such as allergic nasal conjunctivitis symptoms such as itchy nose, sneezing, runny nose, itchy eyes, and tears. Some patients may be accompanied by throat discomfort, headache, vomiting, etc. . If the asthma attack is severe and prolonged, the patient may have chest pain, which may be related to excessive fatigue and strain in the respiratory muscles. Sudden chest pain should consider the possibility of spontaneous pneumothorax.

It is worth noting that asthma attacks in some patients only feel short of breath. About 15% of asthmatic patients do not feel significant asthma when the forced expiratory volume (FEV1) decreases to 50% of the predicted value in the first second, which may be an adaptation of asthma after chronic illness in chronic patients. Therefore, it is not reliable to evaluate the severity of asthma only by the patient's subjective symptoms, and it is necessary to evaluate the severity of asthma in combination with objective testing.

The symptoms and manifestations of asthma patients can vary depending on the patient's condition, environmental factors, medication and psychological factors. The onset of asthma often has certain precipitating factors. Most patients have obvious regularity or periodicity. For example, patients often have seizures or exacerbations at night, and they occur in obvious seasonalities such as spring and autumn. Some women suffer from menstrual cramps or Asthma attacks or exacerbations during menstruation. Some patients with asthma have no obvious seasonal or periodic seizures. This is more common in patients with a longer asthma course or in patients who have regular seizures and evolved without effective treatment, but there are exceptions. People with asthma often develop symptoms after exercise.

Night asthma check

PaO ₂ decreases in severe cases.

Patients with forced vital capacity asthma are symptomatic tolerant due to long illness, and objective examination of respiratory function is particularly important for disease assessment. The peak expiratory flow rate (PEF) was dynamically measured by a tachymeter before bedtime, after awake at night, and early in the morning. At the same time, PEF was measured in the afternoon to determine the best respiratory function status of the day as a comparison basis.

Through the dynamic observation of the peak speed meter, you can understand the state of asthma, and take corrective measures to avoid misjudgment caused by a single measurement at the consultation. Therefore, the day and night status should be comprehensively evaluated. When the patient is in a stable period, the dynamic peak speed meter monitors Can often prompt changes in the condition, patients should be reminded in time. Usually, asthma patients have an acute attack. PEF gradually decreases a few days ago, and the amplitude of PEF variation increases, which can be treated or treated in time. For patients with suspected sleep apnea-hypopnea syndrome, night polysomnographic monitoring is required.

Nocturnal asthma diagnosis

Asthma patients experience increased symptoms at night, and diagnosis is usually not difficult. However, for middle-aged and elderly asthma, it is often accompanied by other diseases such as heart disease and chronic obstructive pulmonary disease (COPD). Therefore, attention should be paid to the diagnosis of cardiogenic asthma, increased nighttime wheezing of COPD and recurrent micropulmonary embolism. And so on. In fact, most diseases have circadian rhythms that worsen at night, so when certain diseases affect the upper airways (such as allergic rhinitis) and the lower airways, the symptoms can be confused with nocturnal asthma.

Nocturnal asthma treatment

There are few special treatment reports on nocturnal asthma, but the basic pathological changes of nocturnal asthma are the same as other asthma, and they are chronic allergic inflammation of the airway. Therefore, the basic treatment is similar to other asthma treatment, and anti-inflammatory treatment should be the main treatment. However, due to the special pharmacokinetics and pharmacodynamic characteristics at night, the treatment of nocturnal asthma has its special characteristics. At present, nocturnal asthma is mainly administered by inhalation, especially in children and adolescents with asthma. Inhaled drugs include glucocorticoids, 2-receptor agonists, cholinergic blockers, and inflammatory mediator antagonists. ; Inhalation dosage forms include powder inhalation, pressure-controlled quantitative aerosol and oxygen-driven atomization inhalation; inhalation methods include direct and indirect two ways, plus space is more suitable for patients at night.

Nocturnal asthma prevention

How to prevent nocturnal asthma, drugs can be used to expand the trachea and eliminate chronic inflammation is an effective way to control asthma attacks. In the past, aminophylline was often added before bedtime to control, but because this drug quickly became effective, it also failed quickly, and it stimulated the stomach and intestines and affected heart function. The effect was not satisfactory. For several years, the compound medicines Chuan'an, Chuanjing, and Meimei, which were developed with extracts of Chinese medicine Huanghuang, Sophora flavescens, Schisandra chinensis, Radix Astragali, Astragalus and Ganoderma lucidum, can effectively prevent nighttime airway contraction, reduce airway inflammation and reduce airway inflammation. Airway reactivity, with two-way immune regulation, can improve immune function and achieve the purpose of healing.