Nocturnal Asthma: Mechanisms and Chronotherapy

  • M. H. Smolensky
  • G. E. D’Alonzo

Abstract

Asthma is a chronic obstructive airways disease. The underlying abnormalities are excessive contraction of tracheobronchial smooth muscle and hypersecretion of mucus plus musosal edema in association with airways inflammation (Spector 1982). Historical accounts of the disease describe a worsening of symptoms overnight. Nonetheless, most clinicians question the time dependency of this disease or feel that nocturnal asthma is a special subtype of asthma. In the majority of untreated patients asthma worsens, or occurs only, overnight. The increase in cough, wheeze, and breathlessness at this time causes substantial problems for patients (Pfeiffer et al. 1989). A number of hypotheses have been proposed to explain why asthma is so common overnight. These include day-night variations in certain environmental factors such as barometric pressure relative humidity, and ambient temperature; proximity and concentration of various offending antigens; accumulative effects of psychological and physiological stresses during the day; and assumption of a supine posture at night. An alternate explanation for the time dependency of this disease stresses the role of endogenous circadian bio-periodicities in relationship to changes in the external environment during each 24 h (Barnes 1984 a; Smolensky et al. 1981, 1986 a). With regard to chronobiological considerations, successful management of patients entails not only the institution of environmental control methods, but also an understanding of the circadian features of the disease to achieve a chronotherapy of anti-asthma medications (Reinberg et al. 1988a,b; Smolensky et al. 1986b, 1987a).

Keywords

Placebo Corticosteroid Cortisol Flare Acetylcholine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ballard RD, Saathoff MC, Patel DK, Kelly PL, Martin RJ (1989) The effect of sleep on nocturnal bronchoconstriction and ventilatory patterns in asthmatics. J Appl Physiol 67: 243–249PubMedGoogle Scholar
  2. Barnes PJ (1984 a) Nocturnal asthma: mechanisms and treatment. Br Med J 288:1397–1398CrossRefGoogle Scholar
  3. Barnes PJ (1984b) Autonomic control of the airways and nocturnal asthma. In: Turner-Warwick M, Levy J (eds) New pro-spectives in theophylline therapy. International congress and symposium series, no 78. Royal society of medicine, London, pp 5–12Google Scholar
  4. Barnes PJ (1984c) Autonomic control of the airways in nocturnal asthma. In: Barnes PJ, Levy J (eds) Nocturnal asthma. Oxford University Press, Oxford, pp 69–73Google Scholar
  5. Barnes PJ (1985) Circadian variation in airway function. Am J Med 79 (suppl6A):5–9PubMedCrossRefGoogle Scholar
  6. Barnes PJ (1986) State of the art. Neural control of human airways in health and disease. Am Rev Respir Dis 134: 1289–1314PubMedGoogle Scholar
  7. Barnes PJ (1988) Inflammatory mechanisms and nocturnal asthma. Am J Med 85 (suppl 1B): 64–70PubMedCrossRefGoogle Scholar
  8. Barnes PJ (1989a) Autonomic control of the airways and nocturnal asthma as a basis for drug treatment. In: Lemmer B (ed) Chronopharmacology, cellular and biochemical interactions. Cellular clocks series, vol 3. Dekker, New York, pp 53–63Google Scholar
  9. Barnes PJ (1989b) Drug therapy - a new approach to treatment of asthma. N Engl J Med 321:1517–1527PubMedCrossRefGoogle Scholar
  10. Barnes P, FitzGerald G, Brown M, Dollery C (1980) Nocturnal asthma and changes in circulating epinephrine, histamine and Cortisol. N Engl J Med 303 i: 263–267CrossRefGoogle Scholar
  11. Barnes PJ, Chung KF, Page CP (1988) Inflammatory mediators and asthma. Pharmacol Rev 40: 49–84PubMedGoogle Scholar
  12. Bateman JRM, Pavia D, Clarke SW (1978) The retention of lung secretions during the night in normal subjects. Clin Sci 55: 523–527Google Scholar
  13. Benatar SR (1986) Fatal asthma. N Engl J Med 314: 423–429PubMedCrossRefGoogle Scholar
  14. Bolinger AM, Young KYL, Gambertoglio JG, Newth CJL, Zu-reikat G, Powell M, Leung P, Affrime MB, Symchowicz S, Patrick JE (1989) Influence of food on the absorption of albuterol repetabs. J Allergy Clin Immunol 83:123–126PubMedCrossRefGoogle Scholar
  15. Brooks SM, McGowan K, Bernstein IL; Altenau P, Peagler J (1979) Relationship between numbers of beta-adrenergic receptors in lymphocytes and disease severity in asthma. J Allergy Clin Immunol 63: 401–406PubMedCrossRefGoogle Scholar
  16. Bruguerolle B, Philip-Joet F, Parrel M, Arnaud A (1987) Unequal twice-daily, sustained-release theophylline dosing in chronic obstructive pulmonary disease. Chronobiol Int 4: 381–386PubMedCrossRefGoogle Scholar
  17. Busse WW, Bush RK (1985) Comparison of morning and evening dosing with a 24 h sustained-release theophylline, Uni-phyl, for nocturnal asthma. Am J Med 79 (suppl 6A): 62–66PubMedCrossRefGoogle Scholar
  18. Catterall JR, Rhind GB, Stewart IC (1986) Effect of sleep deprivation on overnight bronchial constriction in nocturnal asthma. Thorax 41: 676–680PubMedCrossRefGoogle Scholar
  19. Catterall JR, Calverley PMA, Brezinova V, Douglas NJ, Brash HM, Shapiro CM, Flenley DC (1982) Irregular breathing and hpyoxaemia during sleep in chronic stable asthma. Lancet 1: 301–304PubMedCrossRefGoogle Scholar
  20. Catterall JR, Rhind GB, Stewart IC, Whyte KF, Shapiro CM, Douglas NJ (1986) Effect of sleep deprivation on overnight bronchoconstriction in nocturnal asthma. Thorax 41: 676–680PubMedCrossRefGoogle Scholar
  21. Catterall JR, Rhind GB, Whyte KF, Shapiro CM, Douglas NJ (1988) Is nocturnal asthma caused by changes in airway cholinergic activity? Thorax 43: 720–724PubMedCrossRefGoogle Scholar
  22. Chan CS, Woolcock AJ, Sullivan CE (1988) Nocturnal asthma: role of snoring and obstruction sleep apnea. Am Rev Respir Dis 137:1502–1504PubMedGoogle Scholar
  23. Chen WY, Chi H (1982) Airway cooling and nocturnal asthma. Chest 81: 675–680PubMedCrossRefGoogle Scholar
  24. Clark TJH, Heztel MR (1977) Diurnal variation of asthma. Brit J Dis Chest 71:87–92PubMedCrossRefGoogle Scholar
  25. Cockcroft DW, Hoeppner VH, Werner GD (1984) Recurrent nocturnal asthma after bronchoprovocation with western red cedar sawdust: association with acute increase in non-allergic bronchial responsiveness. Clin Allergy 14: 61–68PubMedCrossRefGoogle Scholar
  26. Connolly CK (1979) Diurnal rhythms in airways obstruction. Br J Dis Chest 73: 357–366PubMedCrossRefGoogle Scholar
  27. Creemers JD (1988) A multicenter comparative study of sal-buterol controlled release (Volmax) and sustained-release theophylline (Theo-Dur) in the control of nocturnal asthma (abstract). Eur Res J 1 (suppl): 333SGoogle Scholar
  28. D’Alonzo GE, Smolensky MH, Feldman S, Gianotti LA, Emerson MB, Staudinger H, Steinijans VM (1990) Twenty-four-hour lung function in adult patients with asthma: chronoptimized theophylline therapy once daily in the evening versus conventional twice-daily dosing. Am Rev Respir Dis 142: 84–90PubMedGoogle Scholar
  29. Darrow P, Steinijans VW (1987) Therapeutic advantage of unequal dosing of theophylline in patients with nocturnal asthma. Chronobiol Int 4: 349–357CrossRefGoogle Scholar
  30. Davis RS, Larsen GL, Grunstein MM (1983) Respiratory response to intraesophageal acid infusion in asthmatic children during sleep. J Allergy Clin Immunol 72: 393–398PubMedCrossRefGoogle Scholar
  31. Deal EC, McFadden ER, Ingram RH, Strauss RH, Jaeger JJ (1979) Role of respiratory heat exchange in production of exercise-induced asthma. J Appl Physiol 46: 467–475PubMedGoogle Scholar
  32. Dethlefsen U, Repges R (1985) Ein neues Therapieprinzip bei nächtlichem Asthma. Med Klin 80: 40–47Google Scholar
  33. De Vries K, Goei JT, Booy-Noord H, Orie NG (1962) Changes during 24 hours in the lung function and histamine hyperreactivity of the bronchial tree in asthmatic and bronchitic patients. Int Arch Allergy 20: 93–101PubMedCrossRefGoogle Scholar
  34. Douglas NJ (1985) Asthma at night. Clin Chest Med 6: 663–674PubMedGoogle Scholar
  35. FitzGerald GA, Barnes P, Brown MJ, Dollery CT (1980) The circadian variability of circulating adrenaline and broncho-motor reactivity in asthma. In: Smolensky MH, Reinberg A, McGovern JP (eds) Recent advances in the chronobiology of allergy and immunology. Pergamon, Oxford, pp 89–94Google Scholar
  36. Frankoff HM, Smolensky MH, D’Alonzo GE, Gianotti L, Hsi B, McGovern JP (1987) Comparison of sustained-release theophylline scheduled conventionally (twice-daily, equal interval in equal amount) versus once-daily morning or evenings on circadian pattern of bronchial patency in asthmatics. Chronobiol Int 4: 421–433PubMedCrossRefGoogle Scholar
  37. Gaultier CL, Reinberg A, Girard F (1977) Circadian rhythms in lung resistance and dynamic lung compliance of healthy children. Effects of two bronchodilators. Respir Physiol 31:169–182PubMedCrossRefGoogle Scholar
  38. Gaultier C, De Montis G, Reinberg A, Motohashi Y (1987) Circadian rhythm of serum total immunoglobulin E (IgE) of asthmatic children. Biomed Pharmacother 41:186–188PubMedGoogle Scholar
  39. Gaultier C, Reinberg A, Motohashi Y (1988) Circadian rhythm in total pulmonary resistance of asthmatic children. Effects of β-agonist agent. Chronobiol Int 5 (3): 285–290PubMedCrossRefGoogle Scholar
  40. Gervais P, Reinberg A, Gervais C, Smolensky MH, De France O (1977) Twenty-four-hour rhythm in the bronchial hyperreactivity to house dust in asthmatics. J Allergy Clin Immunol 59: 207–213PubMedCrossRefGoogle Scholar
  41. Goldenheim PD, Conrad EA, Schein LK (1987) Treatment of asthma by a controlled-release theophylline tablet formulation: a review of the North American experience with nocturnal dosing. Chronobiol Int 4: 397–408PubMedCrossRefGoogle Scholar
  42. Goodall RJL, Earis JE, Cooper DN, Bernstein A, Temple JG (1981) Relationship between asthma and gastroesophageal reflux. Thorax 36:116–121PubMedCrossRefGoogle Scholar
  43. Guilleminault C, Quera-Salva MA, Powell N, Riley R, Ro-maker A, Partinen M, Baldwin R, Nino-Murcia G (1988) Nocturnal asthma: snoring, small pharynx and nasal CPAP. Eur Respir J 1:902–907PubMedGoogle Scholar
  44. Halberg F, Reinberg A (1977) Chronobiological serial sections gauge circadian rhythm adjustment following transmeridian flight and life in novel environment. Waking Sleeping 1:259–279Google Scholar
  45. Halberg F, Johnson EA, Nelson W, Sothern R (1972) Auto-rhythmometry - procedures for physiologic self-measure-ments and their analysis. Physiol Teacher 1:1–11Google Scholar
  46. Henderson WR, Shelhamer JH, Reingold DB, Smith LJ, Evans R III, Kaliner M (1979) Alpha-adrenergic hyperresponsive-ness in asthma. N Engl J Med 300: 642–647PubMedCrossRefGoogle Scholar
  47. Hetzel MR, Clark TJH (1979) Does sleep cause nocturnal asthma? Thorax 34: 749–754PubMedCrossRefGoogle Scholar
  48. Heztel MR, Clark TJH (1980) Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax 35: 732–738CrossRefGoogle Scholar
  49. Hetzel MR, Clark TJH; Branthwaite MA (1977) Asthma: analysis of sudden deaths and ventilatory arrest in hospital. Br Med J 1:808–811PubMedCrossRefGoogle Scholar
  50. Hughes DM, Spiers S, Rivlin J, Levinson H (1983) Gastroesophageal reflux during sleep in asthmatic patients. J Pedi-atr 102: 666–672Google Scholar
  51. Joad JP, Ahrens RC, Lindren SD, Weinberg MM (1987) Relative efficacy of maintenance therapy with theophylline, inhaled albuterol and the combination for chronic asthma. J Allergy Clin Immunol 79: 78–85PubMedCrossRefGoogle Scholar
  52. Jonkman JHG (1987a) Food interactions with once-a-day theophylline preparations: a review. Chronobiol Int 4: 449–458PubMedCrossRefGoogle Scholar
  53. Jonkman JHG (1987b) Food interactions with sustained release theophylline preparations. A review. Clin Pharmacokin 16:162–179CrossRefGoogle Scholar
  54. Kales A, Beall GN, Bajor GF, Jacobson A, Kales J (1970a) Sleep studies in asthmatic adults: relationship of attacks to sleep stage and time of night. J Allergy 41:164–173CrossRefGoogle Scholar
  55. Kales A, Kales JD, Sly RM, Sharf MB, Tijiauw LT, Preston TA (1970b) Sleep patterns in asthmatic children. All night EEG studies. J Allergy 46: 300–308PubMedCrossRefGoogle Scholar
  56. Kunkel G, Jusuf L (1984) Theoretical and practical aspects of circadian rhythm for theophylline therapy. In: Turner-Warwick M, Levy J (eds) New perspectives in theophylline therapy. International Congress and Symposium Servies, no 78. Royal Society of Medicine, London, pp 149–155Google Scholar
  57. Kunkel G, Nigam S, Herold D, Jusuf L, Albright DL (1988) Arachidonic acid metabolites and their circadian rhythm in patients with allergic bronchial asthma. Chronobiol Int 5: 387–394PubMedCrossRefGoogle Scholar
  58. Labrecque G, Bélanger PM (1989) The chronopharmacology of the inflammatory process. Annu Rev Chronopharmacol 2: 291–325Google Scholar
  59. Lewinsohn HC, Capel LH, Smart J (1960) Changes in forced expiratory volume throughout the day. Br Med J 1: 462–464PubMedCrossRefGoogle Scholar
  60. Lopes JM, Tabachnik E, Muller NL, Levison H, Bryan AC (1983) Total airway resistance and respiratory muscle activity during sleep. J Appl Physiol 54: 773–777PubMedGoogle Scholar
  61. Malo JL, Montplaisir J, Monday J, Walsh J (1985) Sleep, breathing and dreams of asthmatic subjects. In: Isles AF, von Wicket P (eds) Sustained release theophylline and nocturnal asthma. Excerpta Medica, Amsterdam, pp 36–43Google Scholar
  62. Martin ME, Grunstein MM, Larson GL (1982) The relationship of gastroesophageal reflux in children with asthma. Ann Allergy 49: 318–322PubMedGoogle Scholar
  63. Martin RJ, Cicutto LC, Ballard RD, Szefler SJ (1988) Airway inflammation in nocturnal asthma (abstract). Am Rev Respir Dis 137: 284Google Scholar
  64. Mascia M (1968) Evaluation of night coughing in asthmatic children. J Asthma Dis 5:163–169CrossRefGoogle Scholar
  65. Mikuni M, Saito Y, Koyama T, Daiguji M, Yamashita I, Yama-zaki K, Honma A, Ui M (1978) Circadian variation in plasma. 3’:5’-cyclic adenosine monophosphate and 3’:5’-cyclic guano-sine monophosphate in normal adults. Life Sci 22:667–671PubMedCrossRefGoogle Scholar
  66. Montplasir J, Walsh J, Malo JL (1982) Nocturnal asthma: features of attacks, sleep and breathing patterns. Am Rev Respir Dis 125:18–22Google Scholar
  67. Moore-Gillon J (1988) Volmax (salbuterol CR 8 mg) in the management of nocturnal asthma: a placebo-controlled study (abstract). Eur Res J 1 (suppl 2): 306SGoogle Scholar
  68. Morrison JFJ, Pearson SB, Dan HG (1988) Parasympathetic nervous system in nocturnal asthma. Br Med J 296: 1427–1429CrossRefGoogle Scholar
  69. Nagel RA, Brown P, Perks WH, Wilson RSE, Kerr JD (1988) Ambulatory pH monitoring of gastroesophageal reflux in “morning dipper” asthmatics. Br Med J 297:1371–1373CrossRefGoogle Scholar
  70. Nelson W, Tong YL, Lee JK, Halberg F (1979) Methods for co-sinor rhythmometry. Chronobiologia 6: 305–323PubMedGoogle Scholar
  71. Neuenkirchen H, Wilkens JH, Oellerich M, Sybrecht GW (1985) Nocturnal asthma: effect of a once per evening dose of sustained release theophylline. Eur J Respir Dis 66:196–204PubMedGoogle Scholar
  72. Nicklas RA (1989) Perspective on asthma mortality-1989. Ann Allergy 63: 578–584PubMedGoogle Scholar
  73. Pfeiffer C, Marsac A, Lockhart A (1989) Chronobiological study of the relationship between dyspnea and airway obstruction in symptomatic asthmatic subjects. Clin Sci 77:237–244Google Scholar
  74. Persson G, Gnosspelius Y, Anehus S (1988) Comparison between a new once-daily, bronchodilating drug, bambuterol, and terbutaline sustained-release, twice daily. Eur Respir J 1: 223–226PubMedGoogle Scholar
  75. Postma DS, Köeter GH, Meurs H, Keyzer JJ (1984) Slow release terbutaline in nocturnal bronchial obstruction: relation of terbutaline dosage and blood levels with circadian changes in peak flow values. Annu Rev Chronopharmacol 1:101–104Google Scholar
  76. Postma DS, Keyzer J J, Löeterm HG, Sluiter HJ, De Vries K (1985) Influence of the parasympathetic and sympathetic nervous system on nocturnal bronchial obstruction. Clin Sci 69: 251–258PubMedGoogle Scholar
  77. Powell ML, Weinberger M, Dowdy Y, Gural R, Symchowicz S, Patrick JE (1987) Comparative steady state bioavailability of conventional and controlled-release formulations of albuterol. Biopharm Drug Disp 8:461–468CrossRefGoogle Scholar
  78. Reinberg A (ed) (1979) Chronobiological field studies of oil refinery shift workers. Chronobiologia 6 (suppl): 1–119Google Scholar
  79. Reinberg A (1989) Chronopharmacology of corticosteroids and ACTH. In: Lemmer B (ed) Chronopharmacology, cellular and biochemical interactions. Dekker, New York, pp 137–167Google Scholar
  80. Reinberg A, Levi F (1990) Dose-response relationships in chronopharmacology. Annu Rev Chronopharmacol 6: 25–46Google Scholar
  81. Reinberg A, Ghata J, Sidi E (1963) Nocturnal asthma attacks; their relationship to the circadian adrenal cycle. J Allergy 34: 323–330PubMedCrossRefGoogle Scholar
  82. Reinberg A, Gervais P, Morin M, Abulker C (1971) Rythme cir-cadien humain du seuil de la response bronchique a 1’acetylcholine. Comptes Rendus Acad Sci (Paris) 272:1879–1881Google Scholar
  83. Reinberg A, Halberg F, Falliers C (1974) Circadian timing of methylprednisolone effects in asthmatic boys. Chronobiologia 1: 333–347PubMedGoogle Scholar
  84. Reinberg A, Gervais P, Ghata J (1977a) Chronobiologic aspects of allergic asthma. In: McGovern JP, Smolensky MH, Reinberg A (eds) Chronobiology in allergy and immunology. Thomas, Springfield, pp 36–63Google Scholar
  85. Reinberg A, Guillet P, Gervais P, Ghata J, Vignaud D, Abulker C (1977b) One-month chronotherapy (Dutimelan, 8–15 mite). Control of the asthmatic condition without adrenal suppression and circadian rhythm alteration. Chronobiologia 4: 295–312PubMedGoogle Scholar
  86. Reinberg A, Gervais P, Chaussade M, Fraboulet G, Duburque B (1983) Circadian changes in effectiveness of corticosteroids in eight patients with allergic asthma. J Allergy Clin Immunol 71: 425–533PubMedCrossRefGoogle Scholar
  87. Reinberg A, Pauchet F, Ruff F, Gervais A, Smolensky MH, Levi F, Gervais P, Chaouat D, Abella M-L, Zidani R (1987) Comparison of once-daily evening versus morning sustained-release theophylline dosing for nocturnal asthma. Chrono-biol Int 4:409–419CrossRefGoogle Scholar
  88. Reinberg A, Smolensky MH, D’Alonzo GE, McGovern JP (1988a) Chronobiology and asthma. III. Timing corticother-apy to biological rhythms to optimize treatment goals. J Asthma 25: 219–248PubMedCrossRefGoogle Scholar
  89. Reinberg A, Touitou Y, Botbol M, Gervais P, Chaouat D, Levi F, Bicakova-Rocher A (1988b) Oral morning dosing of corticosteroids in long term treated cortico-dependent asthmatics: increased tolerance and preservation of the adrenocortical function. Annu Rev Chronopharmacol 5: 209–212Google Scholar
  90. Rhind GB, Connaughton JJ, McFie J, Douglas NJ, Flenley DC (1984) The effect of theophylline on nocturnal wheeze and sleep quality in adults with asthma. Annu Rev Respir Dis 129: A 45Google Scholar
  91. Rivington RN, Calcutt L, Child S, MacLeod PJ, Hodder RV, Stewart JH (1985) Comparison of morning versus evening dosing with a new once-daily oral theophylline formulation. Am J Med 79 (suppl 6 A): 67–72PubMedCrossRefGoogle Scholar
  92. Ryan G, Latimer KM, Dolovich J, Hargreave FE (1982) Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodila-tor, and airway calibre. Thorax 37: 423–529PubMedCrossRefGoogle Scholar
  93. Shelhamer JH, Metcalfe DD, Smith LJ, Kaliner M (1980) Abnormal adrenergic responsiveness in allergic subjects: analysis of isoproterenol-induced cardiovascular and plasma cyclic adenosine monophosphate responses. J Allergy Clin Immunol 66: 52–61PubMedCrossRefGoogle Scholar
  94. Skoogh E-E, Svedmyr N (1984) Beta2-adrenoceptor stimulation inhibits ganglionic transmission in ferret trachea. Am Rev Respir Dis 129: A 232Google Scholar
  95. Sly PD, Landau LI (1986) Diurnal variation in bronchial responsiveness in asthmatic children. Pediatr Pulmonol 2: 344–352PubMedCrossRefGoogle Scholar
  96. Smolensky MH (1989) Chronopharmacology of theophylline and beta-sympathomimetics. In: Lemmer B (ed) Cellular and biochemical aspects of chronopharmacology. Dekker, New York, pp 65–113Google Scholar
  97. Smolensky MH, Halberg F (1977) Circadian rhythm in airway patency and lung volumes. In: McGovern JP, Smolensky MH, Reinberg A (eds) Chronobiology in allergy and immunology. Thomas, Springfield, pp 117–138Google Scholar
  98. Smolensky MH, Reinberg A, Queng JT (1981) The chronobiology and chronopharmacology of allergy. Ann Allergy 47: 237–252Google Scholar
  99. Smolensky MH, Barnes PJ, Reinberg A, McGovern JP (1986a) Chronobiology and asthma. I. Day-night differences in bronchial patency and dyspnea and circadian rhythm dependencies. J Asthma 23: 321–343PubMedCrossRefGoogle Scholar
  100. Smolensky MH, Scott PH, Barnes PJ, Jonkman JHG (1986b) The chronopharmacology and chronotherapy of asthma. Annu Rev Chronopharmacol 2: 229–273Google Scholar
  101. Smolensky MH, D’Alonzo GE, Kunkel G, Barnes PJ (eds) (1987a) Circadian rhythm-adapted theophylline chronotherapy for nocturnal asthma. Chronobiol Int 4: 301–466Google Scholar
  102. Smolensky MH, D’Alonzo GE, Kunkel G, Barnes PJ (1987b) Day-night patterns in bronchial patency and dyspnea: basis for once-daily and unequally divided twice-daily theophylline dosing schedules. Chronobiol Int 4: 303–318PubMedCrossRefGoogle Scholar
  103. Smolensky MH, McGovern JP, Scott PH, Reinberg A (1987c) Chronobiology and asthma. II. Body-time differences in the kinetics and effects of bronchodilator medications. J Asthma 24: 91–134PubMedCrossRefGoogle Scholar
  104. Smolensky MH, Scott PH, Harrist RB, Hiatt PH, Wong TK, Baenzinger JC, Klank BJ, Marbella A, Meltzer A (1987 d) Administration-time dependency of the pharmacokinetic behavior and therapeutic effect of a once-a-day theophylline in asthmatic children. Chronobiol Int 4: 435–447PubMedCrossRefGoogle Scholar
  105. Soutar CA, Costello J, Ijaduola O, Turner-Warwick M (1975) Nocturnal and morning asthma: relationship to plasma corticosteroids and response to Cortisol infusion. Thorax 30: 436–440PubMedCrossRefGoogle Scholar
  106. Spaulding HS, Mansfield LE, Stein MR, Sellner JC, Gremillion DE (1982) Further investigation of the association between gastroesophageal reflux and bronchoconstriction. J Allergy Clin Immunol 69: 516–521PubMedCrossRefGoogle Scholar
  107. Spector SL (1982) (Chairman, Scientific Assembly on Allergy and Clinical Immunology). ATS News, Fall, no 5Google Scholar
  108. Steinijans VW, Trautmann H, Johnson E, Beier W (1987) Theophylline steady-state pharmacokinetics: recent concepts and their application in chronotherapy of reactive airway diseases. Chronobiol Int 4: 331–347PubMedCrossRefGoogle Scholar
  109. Sullivan CE, Zamel N, Kozar LF, Murphy E, Phillipson EA (1979) Regulation of airway smooth muscle tone in sleeping dogs. Am Rev Respir Dis 119: 87–99PubMedGoogle Scholar
  110. Tammeling GJ, De Vries K, Kruyt EW (1977) The circadian pattern of the bronchial reactivity to histamine in healthy subjects and patients with obstructive lung disease. In: Smolensky MH, Reinberg A, McGovern JP (eds) Chronobiology in allergy and immunology. Thomas, Springfield, pp 139–150Google Scholar
  111. Toogood JH, Baskerville JC, Jennings B, Lefcoe NM, Johansson SA (1982) Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid, budesonide. J Allergy Clin Immunol 70: 28–298CrossRefGoogle Scholar
  112. Turner-Warwick M (1984) Definition and recognition of nocturnal asthma. In: Barnes BJ, Levy J (eds) Nocturnal asthma. International Congress and Symposium Series, no 73. Royal Society of Medicine, London, pp 3–5Google Scholar
  113. Turner-Warwick M (1988) Epidemiology of nocturnal asthma. Am J Med 85 (suppl 1B): 6–8PubMedCrossRefGoogle Scholar
  114. Van Aalderen WMC, Postma DS, Loeter GH, Gerritsen J, Knol K (1987) Increase in airway hyperreactivity during the night in asthmatic children. Res Dis 135:460Google Scholar
  115. Whyte KF, Douglas NJ (1989) Posture and nocturnal asthma. Thorax 44: 579–581PubMedCrossRefGoogle Scholar
  116. Wilkens JH, Wilkens H, Heins M, Kurtin L, Oellerich M, Sybrecht GW (1987) Treatment of nocturnal asthma: the role of sustained-release theophylline and oral β-2-mimetics. Chronobiol Int 4: 387–396PubMedCrossRefGoogle Scholar
  117. Wilson NM, Charette L, Thomas A, Silverman M (1984) The acid test for gastroesophageal reflux in children with asthma. Thorax 39: 695–696Google Scholar
  118. Wilson NM, Charette L, Thomson AH, Silverman M (1985) Gastroesophageal reflux in childhood asthma: the acid test. Thorax 40: 592–597PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • M. H. Smolensky
  • G. E. D’Alonzo

There are no affiliations available

Personalised recommendations