In this blog we will look into the nighttime symptoms of asthma and its relation with the disease and associated conditions.
Bronchial asthma is a reversible airway disease. There is a good response to bronchodilators. A person with asthma feels symptomatic improvement when they use a bronchodilator like Albuterol, Combivent, or a nebulizer treatment. The common medications used for asthma are Advair Diskus or HFA, Symbicort inhaler, Dulera inhaler, etc. There are many other inhalers and medications used for the treatment of asthma and its control.
Coughing is the most common symptom of asthma. Although in general, people think wheezing is the common symptom, a cough is the early manifestation of asthma especially at nighttime. Based on the severity of underlying asthma, they have different symptoms and severity. The other symptoms like nighttime awakening, chest tightness, postnasal drip, heartburn are seen in many patients. Many have symptoms of asthmatic bronchitis intermittently when they get sick. Bronchial asthma prevention is key by avoiding the things that one is allergic to like cat, aspirin, specific food if are allergic to like peanut etc. If the asthma symptoms persist then goes into chronic asthma state. Long term uncontrolled asthma can turn into chronic obstructive pulmonary disease after many years or decades of the asthma disease secondary to low grade uncontrolled inflammation into the airways.
The patient with mild, intermittent asthma generally has symptoms of coughing, wheezing, chest tightness for less than twice a week and nighttime symptoms less than twice a month. If they do their peak flow on a regular basis, the variation in the peak flow is less than 20%. Meaning, if their average peak flow is 500 liters a minute it may not drop down less than 400 liters per minute, as they have intermittent symptoms, so a short-acting bronchodilator like albuterol inhaler is generally used in most cases.
In mild, persistent asthma cases where the symptoms are more than twice a week but less than once a day, they do get nighttime symptoms more than twice a month. They have more symptoms than the early group of mild, intermittent asthma. Given the severity, their peak flow also will vary more than 20% and generally around 20-30% variation is present. In the airway situation of average peak flow of 500 liters it may vary by going down between 300 liters to 400 liters. Because there is a grade variation, generally inhaled steroids are used and/or other leukotrene inhibitor medications are used to further control the asthma. Many times, the patient may have associated GERD (gastroesophageal reflux disease) and/or postnasal drip and the nighttime symptoms further get worse.
As the disease progresses, they may have moderate, persistent asthma so they start getting daily symptoms and the need for rescue inhaler or nebulizer is more than twice a week, and once at night in a month. The peak flow variation is also about 30%, so with moderate, persistent asthma there is further increase in severity of the disease. In situations like this, a long-acting bronchodilator needs to be added in conjunction with inhaled steroids and other medications like leukotrene inhibitors are generally added. A short-acting bronchodilator needs to be used during an acute attack or symptoms.
As the disease further progresses it goes into severe, persistent asthma. Most of the patients we see in the office have fairly daily symptoms with limited activity and they also have frequent nighttime symptoms. The peak flow varies by more than 30%. Again, the treatment is inhaled steroids with long-acting bronchodilator and in some cases a steroid needs to be added.
As the asthma progresses, there is associated nasal congestion, sinus congestion, increase in environmental allergies, poor digestion, and a build up of toxins is generally seen. The nighttime coughing is an important symptom of persistent asthma in most cases. Some may be related to postnasal drip at night and/or heartburn symptoms.
When the asthma slowly gets worse, the nighttime symptoms also get worse and when the asthma slowly improves, the nighttime symptoms slowly improve and with that there is improvement in sleep. Watching the nighttime symptom will give an important clue about the progression of the disease, especially the spouse or family member can help to recognize the symptoms and a keep a log of the events which can further help when one sees their physician or healthcare provider. In a future blog, we will discuss how one can alleviate the symptoms by integrative medical treatment. The goal of asthma treatment is to control the symptoms, the postnasal drip, the GERD, and associated triggering factors as much as possible. This may further help in overall improvement of asthma and improve the quality of life.
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