Sutherland E Rand
National Jewish Medical and Research Center and the University of Colorado Health Sciences Center, Denver, CO 80206, USA.
J Allergy Clin Immunol. 2005 Dec;116(6):1179-86; quiz 1187. doi: 10.1016/j.jaci.2005.09.028. Epub 2005 Nov 8.
Nocturnal symptoms and overnight decrements in lung function are a common part of the asthma clinical syndrome. As many as 75% of asthmatic subjects are awakened by asthma symptoms at least once per week, with approximately 40% experiencing nocturnal symptoms on a nightly basis. An extensive body of research has demonstrated that nocturnal symptoms of cough and dyspnea are accompanied by circadian variations in airway inflammation and physiologic variables, including airflow limitation and airways hyperresponsiveness. Alterations in beta2-adrenergic and glucocorticoid receptors and hypothalamic-pituitary-adrenal axis function might play a role in modulating the nocturnal asthma phenotype, and recent studies have suggested that melatonin, a neurohormonal controller of circadian rhythms, might be important as well. Treatment strategies in nocturnal asthma are similar to those used in persistent asthma, although dosing of medications to target optimum effect during periods of nocturnal worsening is beneficial.
夜间症状以及肺功能的夜间下降是哮喘临床综合征的常见部分。多达75%的哮喘患者每周至少被哮喘症状唤醒一次，约40%的患者每晚都会出现夜间症状。大量研究表明，咳嗽和呼吸困难等夜间症状伴随着气道炎症和生理变量的昼夜变化，包括气流受限和气道高反应性。β2-肾上腺素能受体和糖皮质激素受体以及下丘脑-垂体-肾上腺轴功能的改变可能在调节夜间哮喘表型中起作用，最近的研究表明，褪黑素作为昼夜节律的神经激素调节因子也可能很重要。夜间哮喘的治疗策略与持续性哮喘的治疗策略相似，尽管在夜间病情加重期间调整药物剂量以达到最佳效果是有益的。
