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It is well know that asthma worsens at night - infact some patients only have noctural symptoms. When we have asthmatics or children with viral wheeze on the wards we know that they tend to worsen at night - those who were managing on 3-4hrs between inhalers, and in air during the day will often require more freqent nebulisers and oxygen at night.
Children with croup rarely present in the day - its is usually the early hours of the morning.
I've heard several theories on this but am not truely convinced by any of them...
- Spending more time near the allergens of bed bugs and feather pillows at night - I can dispell this one as in hospital we have plastic coated matresses and pillows and meticulous cleaning by the nurses
- Colder air at night - perhaps - but we still get the asthmatic having problems on hot summer nights
- Diurnal cortisol rhythms - with cortisol at its lowest in the early hours there is arguement that this causes breathing to worsen - but my patients often end up on prednisolone, which even when given at night doesn't stop these nocturnal worsenings.