When asthma interrupts sleep in children: what is the best strategy?

Nocturnal symptoms of asthma such as coughing, wheezing, dyspnoea and dyspnoea on awakening are common in children with asthma. This is an important issue since nocturnal symptoms may have a negative influence on the child's life, affecting, for example, school performance or quality of life. Only a minority of the patients report their nocturnal symptoms spontaneously. Doctors should therefore specifically ask if a child is experiencing such symptoms. Nocturnal airflow limitation, induced by an increase in inflammatory activity, is thought to be responsible for these symptoms. Several other factors, both endogenous and exogenous, contribute to this fall in lung function. Therapeutic regimens aim to reduce inflammation and the subsequent constriction of the smooth muscle cell. Environmental measures, like smoke avoidance or house dust mite reduction, can reduce the exposure to exogenous triggers, while inhaled medication acts specifically on the inflammation or smooth muscle cell constriction. Treatment with inhaled corticosteroids has a positive influence on lung function and the degree of bronchial hyperresponsiveness. Since short-acting bronchodilators provide dilation for only 4 to 6 hours, their role in the treatment of nocturnal symptoms is less important, especially in children. Long-acting bronchodilators, such as sustained release theophylline, have been shown to improve nocturnal symptoms and (nocturnal) lung function. However, the small therapeutic range of those agents with respect to plasma concentration is a complicating factor for treatment of children with asthma. Long-acting beta(2) agonists have a positive influence on nightly awakenings and lung function. Some studies indicate, however, that the combination of a long-acting beta(2) agonist with an inhaled corticosteroid is superior to long-acting beta(2) agonists alone.