Nighttime asthma

　　The pathogenesis of nighttime asthma is basically the same as that of general asthma, and it is also a disease characterized by chronic non-specific airway inflammation. It involves various inflammatory cells interacting with each other, with mast cells acting as the main effector cells causing acute asthma, playing a 'trigger' role; while eosinophils are considered to be the main effector cells causing chronic asthma airway inflammation, and it has been confirmed that the percentage and count of eosinophils are inversely proportional to FEV1. In recent years, foreign research on nighttime asthma has found that the number of eosinophils in the peripheral blood and sputum of nighttime asthma patients is significantly higher than that of normal people, indicating that the onset of nighttime asthma is closely related to airway eosinophilic inflammation.

　　Nighttime asthma can be complicated with hypoxemia, pneumothorax, mediastinal emphysema, and in severe cases, it can develop into acute pulmonary edema, lower respiratory tract, and lung infection. Statistics show that about half of asthma attacks are induced by upper respiratory tract viral infections, thereby interfering with the immune function of the respiratory tract, making it easy to develop lower respiratory tract and lung infections. Therefore, it is necessary to strive to improve the immune function of asthma patients, keep the airways unobstructed, clear the secretions in the airways, keep the ward clean, prevent colds, and reduce infections. Once there are signs of infection, appropriate antibiotics should be selected according to the bacteria and drug sensitivity for treatment.

　　Nighttime asthma is a disease characterized by chronic non-specific airway inflammation, with clinical manifestations mainly including wheezing, chest tightness, and cough, as follows:

　　1, Wheezing

　　The wheezing symptoms of asthma patients are characterized by paroxysmal wheezing, accompanied by wheezing sounds, shortness of breath during inhalation, and relatively prolonged exhalation compared to inhalation. Wheezing symptoms often suddenly occur at night or in the early morning, lasting from a few minutes to several hours or even several days, and can be relieved naturally or with treatment.

　　2, Chest tightness

　　Patients feel a sense of urgency in the chest and have difficulty breathing. During an asthma attack, patients feel that they do not have enough air to breathe in, and in severe cases, they even have a feeling of asphyxiation. Chest tightness can coexist with wheezing, or it can only be chest tightness.

　　3, Cough

　　Before an asthma attack, there is often a刺激性 dry cough, and the coughing decreases during the attack, with wheezing as the main symptom. When the attack tends to subside, there is more phlegm, usually colorless or white translucent mucous phlegm, tough in texture, sometimes in rice grain-like or mucous column-like. Some patients may cough out a large amount of colorless or white translucent frothy sputum during the attack or when the attack is subsiding. Coughing can coexist with chest tightness and wheezing, or it can be the only symptom of asthma, such as cough variant asthma, which is characterized by dry cough or little sputum, ineffective with antibiotics, and patients are often misdiagnosed or missed.

　　4. Others

　　In addition to the above symptoms, asthma is often accompanied by other symptoms, such as nasal itching, sneezing, clear nasal discharge, eye itching, and crying, as well as allergic rhinitis symptoms. Some patients may experience symptoms such as sore throat, headache, and vomiting during attacks. If asthma attacks are severe and last for a long time, patients may have chest pain, which may be related to over-fatigue and injury of the respiratory muscles. Sudden chest pain should be considered as a possible spontaneous pneumothorax.

　　It is noteworthy that some patients may only feel short of breath during asthma attacks. About 15% of asthma patients may not feel short of breath when the forced expiratory volume in one second (FEV1) decreases to 50% of the predicted value. This may be a kind of adaptation to asthma in chronic patients after a long illness. Therefore, it is not reliable to evaluate the severity of asthma based solely on the patient's自觉 symptoms, and objective test checks are needed to assess the severity of asthma.

　　The symptoms and severity of asthma in patients can vary due to the severity of the disease, environmental factors, medication, and psychological factors. Asthma attacks often have certain triggers, and most patients have regular or periodic attacks, such as attacks or exacerbations at night or during spring and autumn, which are obvious seasonal variations. Some female patients may experience asthma attacks or exacerbations before or during their menstrual period. Some asthma patients have attacks without a clear seasonal or periodic pattern, which is more common in patients with a long history of asthma or those who have regular attacks but have not been effectively treated. There are also exceptions. Asthma patients often experience symptoms after exercise.

　　Nocturnal asthma should be actively treated to eliminate the cause of the disease and prevent acute attacks, as asthma attacks are closely related to infection, contact with allergens, air pollution, and mental factors. The main preventive measures include the following aspects:

　　1. It is important to actively eliminate the cause of the disease and prevent acute attacks, as asthma attacks are closely related to infection, contact with allergens, air pollution, and mental factors.

　　2. Mental factors are closely related to asthma attacks and remission. Excessive dreaming at night can trigger asthma or worsen the condition, therefore, avoiding mental stimulation is very important for preventing asthma attacks.

　　3. After identifying the allergen, avoid contact with it again, for example: if asthma attacks are induced by indoor dust or mites, it is necessary to keep the indoor environment clean, frequently expose bedding to the sun, and always keep windows open for ventilation to maintain fresh indoor air.

　　4. It is not advisable to keep cats, dogs, and other small animals indoors.

　　The main examination for nocturnal asthma is forced vital capacity. Due to the long duration of illness, asthma patients often become tolerant of their symptoms, and objective respiratory function tests are particularly important for evaluating the condition. Maximum expiratory flow rate (PEF) is dynamically measured with a peak flow meter before bedtime, after awakening at night, and in the morning, and PEF is also measured in the afternoon to determine the best respiratory function state throughout the day as a baseline for comparison.

　　Through the dynamic observation of peak flow meters, one can understand the asthma status, take proper treatment, and avoid incorrect judgment caused by a single measurement at the time of consultation. Therefore, a comprehensive evaluation of the day and night status should be made. At the same time, when the patient is in a stable period, dynamic peak flow meter monitoring can often indicate changes in the condition, and it should be timely reminded to the patient. Usually, asthma patients have an acute attack, and the PEF (peak expiratory flow) may gradually decrease several days before the attack, and the variation range of PEF may increase, so it is advisable to seek medical attention or treatment in time. For those suspected of having sleep apnea syndrome, nocturnal sleep monitoring is required.

　　For patients with nocturnal asthma, they can eat more water chestnuts, white radish, walnuts, red dates, euryale ferox, lotus seeds, yam, etc., which have the effects of invigorating the spleen and resolving phlegm, benefiting the kidney and nourishing the lung. They have a certain effect on preventing and treating asthma attacks. Eggs, milk, lean meat, chicken, fish, etc., can supplement the protein consumed due to asthma and enhance resistance. Products such as soy milk and tofu are beneficial to asthma patients, and vitamin A is beneficial for preventing and treating asthma. At the same time, one should eat more green leafy vegetables and orange-yellow vegetables, which are rich in carotene. Carotene can be converted into vitamin A in the body.

　　The main traditional Chinese medical treatment methods for nocturnal asthma are as follows:

　　1. Schisandra chinensis 250 grams, 10 fresh red-shelled eggs. First boil the Schisandra chinensis into a decoction, then cool it and put the eggs with the shell into the decoction to soak for 5-7 days. Every morning, take a hot water or hot yellow wine to serve 1 egg without shell, add a suitable amount of sugar when taking it.

　　2. Fresh red radish 150 grams, dried tangerine peel 9 grams, add a suitable amount of rock sugar, decoct with water, take twice a day.

　　3. Fresh lily bulb 50 grams, almond 10 grams (peeled and crushed), glutinous rice 50 grams, 2 slices of ginger, cook into a thin gruel, add a suitable amount of sugar and take it warm.

　　4. Coix Seed 9 grams, fried and ground into powder, 20 dates, add 500 milliliters of water, boil to 200 milliliters, add the powder of Coix Seed and boil for another 10 minutes, take the decoction with the soup.