Wheezing at night with cough: Nocturnal Asthma (Nighttime Asthma) Prevention & Treatment
Nocturnal Asthma (Nighttime Asthma) Prevention & Treatment
Written by WebMD Editorial Contributors
Medically Reviewed by Jennifer Robinson, MD on August 12, 2022
- Nighttime Asthma and Sleep Disturbance
- Nocturnal Asthma Causes
- How Is Nocturnal Asthma Treated?
Nocturnal asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma symptoms.
Nocturnal or nighttime asthma is very serious. It needs a proper asthma diagnosis and effective asthma treatment.
The chances of experiencing asthma symptoms are higher during sleep. Nocturnal wheezing, cough, and trouble breathing are common yet potentially dangerous. Many doctors often underestimate nocturnal asthma or nighttime asthma.
Studies show that most deaths related to asthma symptoms such as wheezing happen at night.
The exact reason that asthma is worse during sleep are not known, but there are explanations that include increased exposure to allergens; cooling of the airways; being in a reclining position; and hormone secretions that follow a circadian pattern. Sleep itself may even cause changes in bronchial function.
Increased Mucus or Sinusitis
During sleep, the airways tend to narrow, which may cause increased airflow resistance. This may trigger nighttime coughing, which can cause more tightening of the airways. Increased drainage from your sinuses can also trigger asthma in highly sensitive airways. Sinusitis with asthma is quite common.
Asthma problems may occur during sleep, despite when the sleep period is taking place. People with asthma who work on the night shift may have breathing attacks during the day when they are sleeping. Most research suggests that breathing tests are worse about four to six hours after you fall asleep. This suggests there may be some internal trigger for sleep-related asthma.
Lying in a reclining position may also predispose you to nighttime asthma problems. Many factors may cause this, such as accumulation of secretions in the airways (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, and increased airway resistance.
Breathing colder air at night or sleeping in an air‑conditioned bedroom may also cause loss of heat from the airways. Airway cooling and moisture loss are important triggers of exercise‑induced asthma. They are also implicated in nighttime asthma.
If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. It’s worse when lying down or if you take medications for asthma that relax the valve between the stomach and esophagus. Sometimes, acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. If stomach acid backs up to your throat, it may drip down to the trachea, airways and lungs, leading to a severe reaction. This can involve airway irritation, increased mucus production, and airway tightening. Taking care of GERD and asthma with appropriate medications can often stop nighttime asthma.
Late Phase Response
If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. This acute asthma attack ends within one hour. About 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. This phase is called the late phase response, and it is characterized by an increase in airway responsiveness, development of bronchial inflammation, and a more prolonged period of airway obstruction.
Many studies report that when allergen exposure occurs in the evening instead of in the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity.
Hormones that circulate in the blood have well‑characterized circadian rhythms that are seen in everybody. Epinephrine is one such hormone, which exerts important influences on the bronchial tubes. This hormone helps keep the muscle in the walls of bronchi relaxed so the airway remains wide. Epinephrine also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. Your epinephrine levels and peak expiratory flow rates are lowest at about 4:00 a.m., while histamine levels tend to peak at this same time. This decrease in epinephrine levels may predispose you to nocturnal asthma during sleep.
There is no cure for nighttime asthma, but daily asthma medications, such as inhaled steroids, are very effective at reducing inflammation and preventing nocturnal symptoms. Since nocturnal asthma or nighttime asthma may occur anytime during the sleep period, asthma treatment must be sufficient to cover these hours. A long-acting bronchodilator delivered in an asthma inhaler can be effective in preventing bronchospasm and symptoms of asthma. If you suffer from nocturnal asthma, you may also benefit from a long-acting inhaled corticosteroid. If you suffer with GERD and asthma, ask your doctor about medication that reduces acid production in the stomach. Avoidance of potential allergy triggers such as dust mites, animal dander, or feathers in a down comforter may also be very helpful in preventing allergies and asthma and nocturnal asthma attacks.
In addition, using your peak flow meter, you can monitor how your lung function is altered throughout the day and night. Once you notice this altered pattern of lung function, talk with your doctor about a plan to resolve your nighttime asthma symptoms. According to your type of asthma and asthma severity (mild, moderate, or severe), your doctor can prescribe treatment to help you resolve your nighttime asthma symptoms so you can sleep like a baby.
Asthma at Night: Causes, Symptoms, Treatment and More Information
If you have asthma, you may notice that your symptoms are worse at night – you are not alone. More than five million people in the UK have asthma and night-time asthma, also known as nocturnal asthma, is thought to affect up to three quarters of them.
Symptoms of nocturnal asthma include coughing fits, tightness in the chest, wheezing and shortness of breath just before and during sleep. Sufferers can be woken up several times, leading to tiredness, poor concentration and difficulty controlling asthma symptoms during the day, in both adults and children. This can have a significant impact on quality of life.
More asthma-related deaths and severe attacks happen at night, so nocturnal asthma is a serious condition that requires preventative steps and effective treatment. The exact reason why asthma might be worse for some people at night is unclear although certain factors are thought to play a role and there are things you can do to minimise your risk.
Causes and triggers of Night-time asthma
It is not known exactly why asthma is worse at night for some people, although there are certain factors that can make asthma attacks at night more likely. Triggers for asthma attacks at night are:
- Sleeping position. Certain sleeping positions, such as lying on your side or your front, can constrict your lungs, potentially making nocturnal asthma symptoms worse. Meanwhile, sleeping flat on your back can cause mucus in your nose to drip to the back of your throat and trigger a night-time cough.
- Breathing in cold air. A cool room is better for sleep but your night-time asthma might be worse in winter or if you sleep in an air-conditioned room. This is because cold air is dry – loss of moisture and heat in the airways can trigger an asthma attack.
- Exposure to allergens at night. House dust mites in your bedding or mattress, and pet dander, dust particles or mould in your bedroom can all irritate your airways and make you more prone to nocturnal asthma.
- Exposure to allergens during evening. Being exposed to allergens in the evening , from pollen to pet hair, can cause a delayed or ‘late phase’ response. You may experience airway obstruction several hours later, increasing your risk of an asthma attack during the night.
- Poorly controlled day-time asthma. Not following your asthma treatment plan properly during the day can put you at greater risk of suffering from night-time asthma attacks.
- Lung function changes. Natural bodily processes during sleep can make you more prone to nocturnal asthma. Lung function is naturally lower at night. As muscles relax during sleep, the upper airway narrows and leads to increased resistance in the lungs. This means you are more likely to suffer breathing difficulties and coughing fits during the night.
- Hormonal changes. During sleep, your body goes through hormonal changes that might make your asthma worse. Some studies, for example, have shown that decreased levels of cortisol during sleep contribute to airway obstruction.
Nocturnal asthma symptoms
Asthma symptoms occur when the airway becomes inflamed and constricts to make breathing difficult. Common nocturnal asthma symptoms are:
- Shortness of breath
- Chest tightness
In addition, other effects of nocturnal asthma on adults and children include:
- Lack of concentration during the day
- Excessive daytime sleepiness
- Difficulty controlling daytime asthma symptoms.
If you have asthma symptoms at night, but have not been diagnosed with asthma, you should see a doctor or nurse specialist. If you do have a diagnosis, you should make sure that potential night-time triggers have been addressed in your asthma plan.
Certain groups of people with asthma are more likely to experience nocturnal asthma due to certain risk factors which include:
- Excess weight around the chest and abdomen might constrict the lungs while fatty tissue produces inflammatory substances that could affect lung function. Some studies have shown people with asthma who lost weight had improved lung function at night.
- Smoking damages your lungs and will make you more prone to asthma symptoms including asthma attacks at night.
- Allergic rhinitis. One study found poor treatment of allergic rhinitis was linked to a 50% increase in asthma symptoms at night. The condition causes excess mucus to accumulate during sleep and this irritates the throat, which could trigger a coughing fit.
- Sinusitis has been linked with more severe cases of asthma. The condition, a type of viral infection of the sinuses, causes a nasal discharge that can aggravate your asthma as you sleep and wake you with the need to cough.
- Obstructive sleep apnoea (OSA). With this condition, the throat muscles relax during sleep, obstructing the airways, and research has shown a link between OSA and nocturnal asthma.
- Acid reflux. People with asthma are twice as likely to develop a form of chronic acid reflux that flares up at night, known as gastroesophageal reflux disease (GERD). One theory is that acid reflux can cause a bronchial spasm making it harder to breathe and this is worse when you lie down.
- Although the evidence is still inconclusive, some research suggests that stress triggers an immune response that might inflame the airways, leading to an increased likelihood of an attack in people with asthma.
How to prevent night-time asthma
While there is no cure for asthma, there are plenty of way to help prevent night-time asthma and remedies to stop an asthma cough at night. Tips for reducing the symptoms of nocturnal asthma are:
- Keep your bedroom environment clean and free of allergens. Do not allow pets in your bedroom; wash bed linen regularly at a hot temperature to remove house dust mites; air your bedroom and treat any mould on walls; avoid using duvets and pillows with feathers.
- Regulate bedroom room temperature at night. Make sure windows are closed, avoid air conditioning and invest in an air purifier for better quality air in your bedroom.
- Treat underlying conditions: If you suffer from an underlying condition such as GERD, allergic rhinitis or obstructive sleep apnoea, make sure you are taking steps to treat and control it. Research shows, for example, that people who take medication for GERD have fewer asthma attacks and night-time asthma symptoms. Take the appropriate medication and any lifestyle steps such as dietary changes to ease acid reflux.
- Keep your reliever inhaler close by. Keep your inhaler next to your bed so that you can use it if you have a coughing fit during the night.
- Keep water by your bed. Sip some water when your symptoms start to flare up. Moisture will soothe the airways and help relieve your night-time cough.
- Breathing exercises. Different breathing techniques are used to alleviate asthma symptoms and can help you stop an asthma cough at night. If you wake up coughing, you could try a breathing exercise to help control your cough.
- Have an asthma review with your GP or practice nurse. They can check you are using your inhalers correctly and discuss any possible triggers for your nocturnal asthma.
- Follow an asthma treatment plan. Keep your asthma under control by using your medication properly, tracking your symptoms, following an effective asthma treatment plan and adjusting medication if necessary, with the advice of your doctor.
- Maintain a healthy weight. Eat a balanced diet and exercise to keep your weight under control.
- Quit smoking.
What is the best position to sleep with asthma?
Alleviating some of your nocturnal asthma symptoms can be as simple as changing your sleeping position. One study found that the supine sleep position (lying on your back) improved night-time asthma symptoms and constricts your lungs less than lying on your stomach or side.
The best sleeping position for asthma patients is to prop yourself up with extra pillows. This will help to keep the airways open and reduce your risk of a night-time cough.
Nocturnal asthma medical treatment
There is no cure for nocturnal asthma, although there are treatments to get it under control. Discuss your symptoms with your GP or asthma nurse and they will be able to recommend the best treatment plan for you. Medical treatment for nighttime asthma could include:
- Preventer inhaler. This delivers a dose of steroid medicine that you breathe in to damp down inflammation and swelling in the airways. Using a preventer inhaler regularly builds up protection so you are less sensitive to triggers. Good day-time control of your asthma will reduce flare-ups at night.
- Reliever inhaler. This delivers a dose of fast-acting medicine such as salbutamol that will open up the airways and help relieve the symptoms of nocturnal asthma. Keep it beside your bed so you can use it as soon as you have an attack at night.
- Combination inhalers. If your other inhalers are not helping, you might need a combination inhaler that mixes the medication and stops symptoms occurring while also providing relief if they do occur.
- Leukotriene Receptor Antagonists (LTRAs). This medicine is given in tablet-form and sometimes used in addition to inhalers to help with severe asthma symptoms and night-time attacks.
why children and adults cough and wheeze when breathing, treatment options
Published: 22 February
Updated: 08 February
Reading time: 7 minutes
The appearance of a cough with wheezing indicates that mucus has accumulated in the respiratory organs and the larynx has narrowed. The causes of wheezing can be diseases of the respiratory, cardiovascular system and other pathologies that can be dangerous. If such a cough occurs, you need to consult a doctor in order to diagnose in time and prescribe competent treatment.
Causes of cough with wheezing
Wheezing may occur on inhalation and exhalation when the airway is narrowed due to the formation of mucus clots or other mechanical obstructions. Cough, accompanied by wheezing, noisy breathing, is wet or dry. It may be accompanied by fever, a feeling of general malaise.
Depending on the disease, its complexity and course, wheezing occurs during or after coughing. By their nature, they are small-bubble, large-bubble, bass, whistling. The nature of wheezing and coughing, revealed after examination and auscultation of the lungs, helps the doctor determine the diagnosis of the disease.
The most common diseases that cause coughing and wheezing when breathing:
- lobar pneumonia.
Cough with wheezing may occur if the disease is advanced and the previous viral infection has not been treated properly. Other reasons include the anatomical features of the structure of the cartilaginous framework and trachea, the ingress of a foreign body into the throat, squeezing the airways by the lymph nodes, smoking, occupational diseases due to work in hazardous industries. Wheezing can occur as a result of oncology, diseases of the cardiovascular system, when blood stagnates in the vessels of the lungs.
Cough with wheezing in a child
The appearance of wheezing in a child’s throat should cause to urgently call or visit a pediatrician . Children under adolescence and infants have smaller airways than adults, so mucus clots can lead to risks of suffocation.
Many infectious diseases are characterized by coughing attacks at night, when the child wakes up in a sweat, complains of sore throat, shortness of breath. Before the arrival of the doctor, you need to give him a warm drink, position him lying down or half-sitting.
Cough with wheezing in an adult
When breathing is difficult and wheezing occurs during coughing, this may be a sign of a serious illness, not necessarily related to the pathology of the respiratory tract. It is recommended to consult a general practitioner first. The doctor will conduct an examination and refer you to a specialist: pulmonologist, cardiologist, hematologist, oncologist. It is imperative to seek medical help if a cough with wheezing is accompanied by:
- shortness of breath;
- blue skin;
- acute pain behind the sternum;
- profuse expectoration;
- unusual consistency of sputum – for example, it is too thick, watery, contains blood, pus;
- an increase or decrease in temperature that lasts for a long time;
- increased sweating;
- weight loss without dietary changes.
If there is a severe attack of coughing with wheezing, you need to call an ambulance, unfasten clothing and a belt that makes breathing difficult. The patient must take a lying or half-sitting position, raise his head.
Treatment of cough with wheezing
The earlier treatment is started, the less the risk of complications. The doctor listens to the chest, examines and, based on the test results, prescribes specific drugs and therapy measures:
- antibiotics — if a bacterial nature of the disease is detected;
- antihistamines for allergies or SARS;
- bronchodilators – for cough due to bronchial constriction;
- antipyretics – at body temperature above 38. 5 degrees;
- mucolytics – for intensive secretion of viscous sputum in order to thin it.
The doctor will advise you to limit physical activity, eliminate bad habits and stress. A special hypoallergenic diet may be prescribed. If the cause of wheezing is diseases of the cardiovascular system, tumors, then appropriate drugs and methods are prescribed: chemotherapy, radiation therapy.
The treatment includes gargling with saline solution, decoctions of medicinal herbs. Rinsing soothes irritated mucous membranes, relieves inflammation, and helps prevent the discharge of mucus from entering back into the nasopharynx. Inhalations and heating can be carried out only after consulting a doctor: they are contraindicated in certain diseases – tuberculosis, lung abscess. As additional procedures, electrophoresis, laser heating are prescribed.
To alleviate the condition of the sick person, it is necessary to help the removal of sputum, reduce inflammation and swelling. One of the drugs of combined action is Rengalin. It is combined with other cough medicines. The three-component composition of the drug has an antitussive, anti-inflammatory, bronchodilator effect. The drug can be used by adults and children from three years of age.
Rengalin is formulated as an oral solution and lozenges that do not require water, so they can be taken anywhere to treat coughs.
Rengalin is the most prescribed antitussive drug. According to the 2019 RxTest™ Prescribing Audit. Database “Market research system “Pharmxplorer”, conducted by Proxima Research LLC.
Rengalin No. 1 on the Russian market of cough medicines. Monthly monitoring of the pharmaceutical market DSM Group, November 2022
Cough with wheezing: causes and treatment of cough
What is the difference between a normal cough and a wheezing cough?
What diseases cause a cough with wheezing?
When do you need to see a doctor urgently?
How to treat a cough with wheezing?
Preparations Doctor MOM ® in the treatment of cough with wheezing
Cough is one of the most common symptoms accompanying respiratory diseases, allergic reactions and even disorders of the upper digestive system. Depending on what caused the cough, it can vary in frequency and intensity of attacks, volume and consistency of secretions, and also have various accompanying symptoms. One of them is wheezing. This sign can be quite “eloquent” and indicate the accumulation of mucus in the bronchi, narrowing of the airway lumen and other undesirable conditions. Therefore, a cough with wheezing is a reason to see a doctor as soon as possible.
What is the difference between a normal cough and a wheezing cough?
Common cough . Strong, sharp exhalations are caused by irritation of receptors located on the entire surface of the mucous membrane of the respiratory tract. Thanks to coughing, the lumen of the respiratory organs is freed from the accumulation of mucus, foreign particles and everything that prevents the passage of air.
But in diseases of the respiratory tract, the characteristics of cough can change:
superficial “barking” cough is often observed with laryngitis, tracheobronchitis and is a separate cough shocks, the so-called cough;
paroxysmal cough – a series of violent coughing shocks that can last up to several minutes, often caused by bronchitis, whooping cough or insufficient volume / high viscosity of bronchial mucus, which makes it difficult to remove.
Cough with wheezing . With such a cough, regardless of its duration or intensity, distinct wheezing in the chest is heard when inhaling and / or exhaling. This sound is the result of air passing through a narrowed airway or through a buildup of mucus. In this case, wheezing can be dry (with laryngitis, tracheitis, bronchitis) or wet (with diseases accompanied by accumulations of sputum in the respiratory system, and with friction of the walls of the bronchi against the lungs).
Wheezing itself can be whistling, bass, sonorous, silent. They may appear only during episodes of coughing or even outside of them. The combination of all the characteristics of a cough gives the doctor an idea of what disease he is dealing with.
What diseases cause wheezing cough?
The list of diseases that cause coughing and wheezing in the chest is quite long. But the most common causes of this symptom include the following:0108
laryngitis – inflammation of the mucous membrane of the larynx, in which its lumen narrows due to swelling, can cause wheezing during inhalation or exhalation, when coughing;
tracheitis – inflammation of the tracheal mucosa, dry rales may be observed when the condition is neglected;
pharyngitis – inflammation of the mucous membrane of the pharynx, can quickly spread to the underlying organs of the respiratory system, causing wheezing in the chest when coughing;
bronchitis – inflammation of the bronchial mucosa, quite often accompanied by cough, which is accompanied by wheezing some time after the onset of the disease;
allergy – upon contact with an allergen, the respiratory organs may react with inflammation and swelling. This narrows the airway, which can cause wheezing when coughing;
bronchial asthma is a chronic inflammation of the airways, in which periodic narrowing of the bronchial lumen and the release of a large amount of mucus are observed. During such attacks, shortness of breath and wheezing appear, caused by obstructed air circulation.
In fact, any infectious or inflammatory disease of the respiratory tract can cause a wheezing cough if not treated promptly. This leads to a deterioration in the excretion of mucus, its thickening and the formation of a mechanical obstacle to the inhaled and exhaled air. Cough syrup and lozenges Dr. MOM ® help relieve inflammation and relieve cough. Early initiation of treatment avoids a number of complications and speeds up recovery.
When do you need to urgently see a doctor?
Coughing and wheezing when breathing may indicate the onset of a serious illness. In the presence of such symptoms, it is very important to seek qualified help from a doctor.
This is especially important if the cough with wheezing is accompanied by one or more of the following symptoms:
Considering that wheezing during coughing can be symptoms of a wide variety of diseases, you should always consult a doctor. Only a qualified specialist can make an accurate diagnosis and recommend how to treat the identified disease.
How to treat a cough with wheezing?
What to do with a cough with wheezing, as mentioned above, depends on the disease that caused this symptom. After a comprehensive examination and diagnosis, the doctor may prescribe several drugs from various drug groups.
Antibiotics . They are prescribed for diseases caused by pathogenic bacteria. Antibacterial drugs inhibit the vital activity of these microorganisms and cause their death, but should be selected only by a doctor and solely taking into account the sensitivity of microbes to certain drugs. Antihistamines . This group of medicines is prescribed for cough and other respiratory, skin or gastrointestinal symptoms caused by allergies. Also, antihistamines can be included in the complex of drugs prescribed for ARVI. Bronchodilators . This group of drugs is recommended for coughing with wheezing, which are caused by narrowing of the bronchial lumen. They help to normalize breathing, eliminate shortness of breath, restore the function of removing sputum from the bronchi. This group of drugs has different mechanisms of action, so a specific drug should be selected by the attending physician based on the specifics of the situation. Mucolytic . These funds thin the sputum and prevent it from settling on the walls of the bronchi. This facilitates the elimination of both the actual mucus and pathogens, toxic products of their vital activity. Dr. MOM ® cough syrup and lozenges have pronounced mucolytic and bronchodilator effects, which are based on the action of a complex of medicinal plants. Antipyretics . They can be recommended at elevated body temperature. An integrated approach to the treatment of cough with wheezing of any origin is important, since it is only one of the symptoms of the disease.