Abstract
Nocturnal worsening of asthma is very common and employed in clinical practice as a marker of asthma severity. The fall in overnight lung function can reach 50%. Several mechanisms contribute to this circadian (24 h) variation. Cortisol, steroid responsiveness, vagal tone, leukotriene, airway inflammation and airway hyperresponsiveness vary in a circadian fashion and have been described as potential mechanisms. Studies on the ability of corticosteroids to block circadian recruitment of inflammatory cells show that a single corticosteroid systemic dose in the afternoon results in a significant pancellular reduction in bronchoalveolar lavage cytology at 4: 00 h and a reduction in the overnight fall in FEV1. The same single dose in the morning or night does not lead to significant improvement. Further studies on chronotherapy of asthma have revealed a rapid and time-dependent effect of inhaled steroids. A single dose of inhaled steroid in the afternoon has a protective effect against asthma worsening in the same night. Chronotherapeutic principles are also applied with other than corticosteroid drugs in the regular asthma treatment.
Keywords: asthma, circadian rhythm, chronotherapy, airway hyperresponsiveness, bronchial inflammation
Current Respiratory Medicine Reviews
Title: Mechanisms and Therapeutic Implications of Asthma Circadian Rhythm
Volume: 1 Issue: 2
Author(s): Elcio O. Vianna
Affiliation:
Keywords: asthma, circadian rhythm, chronotherapy, airway hyperresponsiveness, bronchial inflammation
Abstract: Nocturnal worsening of asthma is very common and employed in clinical practice as a marker of asthma severity. The fall in overnight lung function can reach 50%. Several mechanisms contribute to this circadian (24 h) variation. Cortisol, steroid responsiveness, vagal tone, leukotriene, airway inflammation and airway hyperresponsiveness vary in a circadian fashion and have been described as potential mechanisms. Studies on the ability of corticosteroids to block circadian recruitment of inflammatory cells show that a single corticosteroid systemic dose in the afternoon results in a significant pancellular reduction in bronchoalveolar lavage cytology at 4: 00 h and a reduction in the overnight fall in FEV1. The same single dose in the morning or night does not lead to significant improvement. Further studies on chronotherapy of asthma have revealed a rapid and time-dependent effect of inhaled steroids. A single dose of inhaled steroid in the afternoon has a protective effect against asthma worsening in the same night. Chronotherapeutic principles are also applied with other than corticosteroid drugs in the regular asthma treatment.
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Cite this article as:
Vianna O. Elcio, Mechanisms and Therapeutic Implications of Asthma Circadian Rhythm, Current Respiratory Medicine Reviews 2005; 1 (2) . https://dx.doi.org/10.2174/1573398054023019
DOI https://dx.doi.org/10.2174/1573398054023019 |
Print ISSN 1573-398X |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6387 |
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