Expert: Marc Rubin, RPh Asthma Educator - 9/27/2009

Question
Can asthma become dangerous at night? For example, can you have an asthma attack while you are sleeping?

Answer
Hi Brittany,

Yes, asthma can become more dangerous at night.

To understand what is taking place, you first have to appreciate the the body functions in cycles. In the female, the reproductive cycle with estrogen and progesterone runs through a cycle of approximately 28 days. A rise and fall of the two hormones occur which trigger the release of the egg, and prepare the uterus for impregnation within an approximate 3 day window. If fertilization does not occur, progesterone levels drop, resulting in menses, and the whole cycle begins again.

Now, in regards to your lungs, the adrenal glands above your kidneys secrete anti-inflammatory steroids in a 24 hour cycle. It kicks in ~ 6am, peaks about 2pm, and nearly shuts down at midnight. By 4am, the levels are low, and inflammation, since midnight, increases. This results in more swelling of the lung tissues through the night. This steroid cycle happens in all people, but is obviously of medical concern in patients, like asthmatics, with inflammation issues. At the other end, your breathing is generally best in the early afternoon.

What is noted is night-time awakenings, generally with cough or wheezing, that requires rescue treatment. If this happens more than 2 times in a 4 week period of time, the patient needs to be on a daily controller medication, such as Singulair, Flovent, Pulmicort, Advair, Symbicort, or any one of the other maintenance therapies. The appropriate therapy is generally best determined by an allergist by evaluation of what trigger issues are present.

Asthma is best controlled by a combination of medication therapy, equally balanced with disease knowledge and avoidance of triggers which specifically effect you. First I'd suggest being properly evaluated by a specialist. Second, learn as much as you can about this illness. The more you understand, the better your long-term quality of life will be. There is very little an asthmatic in control cannot due, that someone without this illness can. At the extreme, there are Olympic athletes with asthma, some with severe asthma. But they have learned to be in control.

You've taken an important first step in this direction. If you'd like, send me another email, but marked PRIVATE, with your name, birthdate and email address. You will then be enrolled in a free series of asthma courses provided by Emmi Solutions. As I am an adviser for this program, there is no charge. There is also no advertising, or redistribution of your information. It is all kept confidential.

Also, should you not have prescription insurance, and these meds are costly, let me know, and I can provide resources to you that make these same products available at a significant savings.

Hope to hear from you soon!

Sincerely,

Marc