[Nocturnal asthma].

Nocturnal asthma is one of the difficult form of asthma. It is associated with significant decline in pulmonary function and increase of airway inflammation at night. The pathophysiological mechanisms underlying the nocturnal aggravation of asthma are intricate. The most important seem to be: nocturnal environmental allergens, exacerbation of airflows and circadian variations of bronchial hyperreactivity, beta adrenergic receptors polymorphism, increased vagal tone. Home PEF monitoring will allow an objective assessment of nocturnal asthma. The physician-patient partnership is important in educating the patient to manage nocturnal episodes. The chrono-therapeutic approach will usually include inhaled or oral corticosteroids with the addition of theophylline, long-acting beta agonists with timing of therapy to give adequate effect during the night.