Nocturnal Asthma—ENT Disorders That Contribute

Allergies, GERD, Sinusitis and Sleep Apnea

Woman suffering from nocturnal asthma.
Woman suffering from nocturnal asthma. GARO/PHANIE/Getty Images

Nocturnal asthma is an aggravation of asthma during the nighttime hours. Just because you have asthma, however, does not mean that you will experience a worsening of asthma symptoms at night. In fact, why people experience worsening asthma symptoms and a reduced quality of sleep is not well understood. There is evidence that suggests that many disorders of the ears, nose and throat can increase the likelihood of you experiencing nocturnal asthma.

Prevalence of Nocturnal Asthma

If you have a diagnosis of asthma, you will likely at some point in time experience the symptoms of nocturnal asthma. However, on a consistent basis, only about 47 out of 100 asthmatics will experience nocturnal asthma on a daily basis. If your child is diagnosed with asthma, though, they probably have approximately a 30 percent higher risk of experiencing an aggravation of symptoms at night. Aggressive treatment for children and adults should be sought, as daytime drowsiness can affect relations, school or job performance, and overall physical and mental health.

Symptoms of Nocturnal Asthma

The symptoms of nocturnal asthma are straightforward and easy to identify. The three most common symptoms that you will experience that you can identify as nighttime asthma exacerbations include:

  1. coughing
  2. wheezing
  3. breathlessness

The symptoms listed above are caused as you experience inflammation of the airways at the same time that you have a decrease in your overall lung function.

The symptoms may occur as you are lying down trying to go to sleep, or they may wake you up in the middle of the night.

4 Disorders That Can Contribute to Nocturnal Asthma

There are 4 main disorders of the ears, nose, and throat that can contribute to the likelihood of you experiencing an asthma exacerbation at night.

You may see these referred to as comorbid conditions or conditions that are occurring simultaneously. It is important to realize that these conditions are not the cause of nocturnal asthma, but rather they can help predispose you to not only having the episode but may increase your risk for having more frequent episodes.

Allergen exposure can increase the level of inflammation in the airways. Allergens that become trapped in the nasal passages has potential to reach the airways during episodes of snoring. As your airways become inflamed, and the body's natural tendency to have a decrease in lung function at night (due to circadian rhythms) you can experience coughing, wheezing, or breathlessness.

GERD, or gastroesophageal reflux disease, is a disorder where acidic contents from the stomach reflux, or travel, back up the esophagus. When the severity of GERD is high enough, the acidic content can damage the airways as well as the esophagus. Bronchoconstriction, or tightening of the larger airways, can occur even with short-term exposure to acidic stomach contents, which can lead to an exacerbation of your asthma symptoms.

Sinusitis, similar to allergen exposure, can cause inflammation of your airways. Post-nasal drip can come into contact with the airways causing bronchoconstriction. The narrowing of the airways can lead to the symptoms related to nocturnal asthma.

Obstructive sleep apnea (OSA), while considered a condition that can exacerbate nocturnal asthma, does  not have a mechanism that is well understood. However, there are studies that show that using nasal CPAP devices for OSA has been shown to decrease the symptoms of nocturnal asthma. However, CPAP without OSA does not show any effect on asthma symptoms at night.

Treatment of Nocturnal Asthma

Treatment of any underlying comorbid disorders (like allergies, GERD, sinusitis, or OSA) is important in the overall management of nocturnal asthma. Be sure to have any of these conditions optimally treated if you are experiencing nighttime asthma symptoms.

The other area that you need to ensure to have properly treated is your asthma. If you are experiencing one or more symptoms of asthma each week, you may not have optimally-controlled asthma and should discuss improving your medication regimen with your doctor. Common medications to control your asthma include:

  • Inhaled or oral glucocorticoids
  • Long-acting inhaled beta-agonists
  • Theophylline
  • Leukotriene inhibitors

Never increase your medications without consulting a doctor. The best doctor to manage your asthma is a pulmonologist. Relatively minor symptoms of asthma though may be managed by your primary care physician.

Sources:

Ginsberg, D. (2009). An Unidentified Monster in the Bed – Assessing Nocturnal Asthma in Children. Mcgill J Med. 12(1): 31–38.

Martin, RJ. (2015). Nocturnal asthma. Accessed on July 16, 2016 from http://www.uptodate.com (Subscription Required).

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