NOCTURNAL ASTHMA - MECHANISMS AND THERAPY

Nocturnal worsening of symptoms affects a large number of patients suf fering from asthma. Recent studies show that airway inflammation under lies nocturnal awakenings and increased airway hyperreactivity. These studies, however, yield conflicting results concerning the pathogenesi s of the disease, making it difficult to understand the mechanisms inv olved in sustaining nocturnal asthma. This article reviews the princip al pathogenetic mechanisms of nocturnal asthma, showing that worsening of symptoms at night may be the result of a more severe disease as we ll as of increased inflammation at night and higher susceptibility. We also review the pharmacologic treatment of nocturnal asthma which is mainly based on antiinflammatory treatment with inhaled or oral steroi ds or combined therapies with theophylline and beta(2) agonists. The a ctivity of antileukotrine compounds in asthma is also summarized.