Nocturnal Asthma: Causes, Symptoms, Risk Factors In Children And Treatment

A chronic disease, asthma causes inflammation and narrowing of airways in the lungs. It causes wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. During an asthma attack, your airway muscles constrict, and mucous membranes produce excess mucus, blocking your breathing. Allergens such as dust, spores, animal hairs, cold air, infection and even stress can trigger asthma [1].

Some of the most common types of asthma are adult-onset asthma, allergic asthma, nocturnal asthma, asthma-COPD overlap, non-allergic asthma, occupational asthma and childhood asthma [2].

As studies point out, asthma symptoms tend to get worse by night and can disrupt sleep [3]. When asthma worsens at night, it is clinically termed nocturnal asthma and causes wheezing, difficulty breathing etc.

What Is Nocturnal Asthma?

Nocturnal or night-time asthma is a severe form of a chronic condition and can disrupt the sleep and overall living quality of an individual. Nocturnal asthma is common in people diagnosed with asthma and can occur in individuals with any asthma, be it allergic, exercise-induced or occupational [4].

Studies show that 60 per cent of people with asthma report having nocturnal asthma symptoms.

Causes Of Nocturnal Asthma

There is no information regarding the exact cause of nocturnal asthma. However, a recent study pointed out that the disruptions in the circadian rhythm are responsible for worsening the condition at night [5].

Some of the other factors deemed responsible for nocturnal asthma are as follows:

• Increased mucous production
• Sinusitis
• Lower levels of the hormone epinephrine (helps relax and widen airways)
• Higher levels of the hormone histamine (restricts airways)
• A delayed response to an allergen encountered during the daytime
• Exposure to allergens such as dust mites in the mattress at night
• Gastroesophageal reflux disease (GERD)
• Psychological stress
• Sleep-related conditions, such as sleep apnoea
• Sleeping in a reclined position
• Inhaling cold air
• Obesity

Symptoms Of Nocturnal Asthma

The signs and symptoms of nocturnal asthma are primarily similar to that of the symptoms of normal asthma. Here are the symptoms that get worse by night [6]:

• Tightness in the chest
• Shortness of breath
• Severe coughing
• Continuous wheezing

Risk Factors For Nocturnal Asthma

People who already have asthma are the ones who are at the risk of developing nocturnal asthma than people without asthma. The risk factors include the following [7]:

• Obesity
• Smoking habit
• Age (young)
• Allergic rhinitis [8]
• Certain mental health conditions [9]
• Gastrointestinal issues
• Living environment, such as an urban environment

Treatment For Nocturnal Asthma

Similar to normal asthma, there is no specific treatment for nocturnal asthma. The chronic condition can be managed through a variety of methods such as medication, lifestyle and habit changes, diet etc.

Inhaled steroids are the go-to medication for asthma and work in managing nocturnal asthma symptoms and signs [10]. This help reduces inflammation and other symptoms of asthma. Also, a nebulizer can help treat night-time episodes.

The other ways through which you can manage nocturnal asthma are as follows:

• Get help for stress and consult a psychologist if necessary
• Maintain a healthy weight
• Get treatment for GERD [11]
• Quit smoking
• Clean your room and bedding regularly

Nocturnal Asthma In Children

Childhood asthma, also termed paediatric asthma, is the same as that of asthma reported in adults. When a child has asthma, the lungs and airways become easily inflamed when exposed to triggers such as inhaling pollen or catching a cold or other respiratory infection.

The symptoms of this respiratory problem can make it difficult for your child to do everyday activities such as going to school, playing and even sleeping. There is no cure for asthma in children, but there are ways through which you can prevent the triggers and hence, limit the damage to the child's growing lungs [12].

According to several studies, about 40 per cent of children with asthma have nocturnal asthma as well [13]. Most of them had moderate to severe nocturnal asthma symptoms and had poorer sleep quality. The other symptoms observed in children with nocturnal asthma are as follows [14]:

• Parasomnias such as hallucinations, abnormal movements, sleepwalking and extreme emotions
• Obstructed breathing
• Night waking

Why Does Asthma Get Worse At Night?

According to the recent research published in The Proceedings of the National Academy of Sciences, the reason behind asthma getting worse at night have been linked to the influence of the circadian rhythm or system, in contrast to sleep and physical activities [15]. The experiments revealed that the circadian rhythms play a significant role in regulating pulmonary function over a daily cycle. And they showed that sleep phases play a significant role in asthma severity independent of circadian effects.

Consequently, while the study findings linked the asthma symptoms to erratic sleep behaviours, there could also be other behaviours or factors that could impact the circadian rhythm.

On A Final Note...

If your asthma signs and symptoms get worse at night, affecting your overall life quality, it is crucial that you get immediate medical attention.