Nighttime Asthma Attacks: How To Help Children Manage Symptoms And Sleep Peacefully

Nighttime asthma, or nocturnal asthma, is characterised by worsening asthma symptoms at night. The airways become inflamed and constricted, making breathing difficult.

Asthma in children requires careful management (Image by Freepik)

Asthma is a chronic lung disease that affects the airways, the tubes that carry air to and from the lungs. Dr Srujan Topale, Consultant-Pediatrician, Manipal Hospital, Kharadi, Pune, shares, "This inflammation narrows the airways, making breathing difficult." Sometimes asthma becomes worse at night and if you have children with asthma, the situation requires careful handling. Dr Topale explains, "Nighttime asthma, also known as nocturnal asthma, is characterised by worsening asthma symptoms during the night. The airways become inflamed and constricted, making breathing difficult.  If a child frequently wakes up at night coughing, wheezing, or struggling to breathe, it's a strong sign their asthma needs better control. Even if a child hasn't received an official asthma diagnosis, persistent coughing or wheezing at night or early in the morning could be early indicators of the condition."

Nighttime Asthma Symptoms

Coughing, wheezing, shortness of breath, and chest tightness can occur, often at night or after exercise, says Dr Topale. "Triggers such as allergens, respiratory infections, cold air, and smoke can worsen these symptoms and even lead to an asthma attack, a potentially life-threatening situation where breathing becomes severely restricted," the doctor adds. Cold air, dust mites, allergens like pet dander, and even emotional stress can worsen asthma at night. Also, the body's natural steroid production decreases during sleep, making the airways more sensitive.

The severity and presentation of symptoms can vary, says Dr Topale. Here are some key points, as per the doctor:

- Symptoms may worsen at night or in the early morning.
- Episodes of coughing and wheezing alternate with symptom-free intervals.
- Persistent or recurrent symptoms with episodes of increased wheezing and coughing.
- Symptoms may fluctuate seasonally due to common infections or allergy triggers.

Triggers Of Nighttime Asthma And How To Protect Kids

"Children can be exposed to asthma triggers even while they sleep. Common triggers in a child’s bedroom include dust mites, feathers from pillows or blankets, Smoke, dust, pests like cockroaches or mice, pets or pet dander, mould, cleaning products, cold air from air conditioning, dry air etc," says Dr Topale.

The doctor suggests the following steps to keep children safe:

Sleep-Conducive Environment: Keeping the bedroom cool (moist/humid), dark, and well-ventilated is important. The use of hypoallergenic bedding and pillows to reduce exposure to allergens is a useful option for good sleep. Keeping the linen clean and dust-free is the key.

Air Quality: The use of an air purifier to remove allergens and dust particles can help maintain air quality. Also, it helps to maintain a comfortable room temperature and humidity level.

Avoid Sleeping With Pets: Keep pets out of the bedroom to prevent dander from accumulating in the carpeting and bedding.

Sleep With An Elevated Head Position: Sleeping with an elevated head position is recommended, especially during instances of a cold, sinus infection, or acid reflux. Lying flat can worsen these conditions and potentially trigger asthma attacks.

Asthma Treatment Strategies

Dr Topale shares the following tips:

1. Preventive Medications: The use of controller medications such as inhaled corticosteroids is important. These medications reduce inflammation in the airways, making them less sensitive to triggers preventing attacks before they occur and making the child symptom-free in the long run

2. Bronchodilators: These medications, often delivered via inhalers, provide short-term and immediate relief by relaxing the muscles surrounding the airways, keeping them open, and preventing nighttime constriction.

3. Leukotriene Modifiers: Taken orally, these medications block immune system chemicals that trigger asthma symptoms. They are added to the treatment plan if inhaled corticosteroids alone are not sufficient. Montelukast Singulair is approved in syrup form for children (can delete -ages 2 to 6 and in granular form for children) as young as 1.

Medication delivery devices are essential for administering asthma treatments, especially for young children, says Dr Topale. These devices include:

Valved holding chamber with face mask spacer with or without face mask: This attaches to a metered dose inhaler MDI and helps children under 5 years old inhale the medicine effectively. The spacer allows the child to take multiple breaths to receive the appropriate dosage of medication.

Nebulizer: This device converts asthma medications into a fine mist that the child breathes in through a face mask. Nebulizers are often used for young children who may have difficulty using other inhaler devices.

"It's important to consult a paediatrician to create the best treatment plan for asthma management in kids. Successfully controlling asthma leads to fewer symptoms and less sleep disruption," says Dr Topale.