![]() ![]() 11 found that adult patients with asthma who smoked had increased nocturnal symptoms. 10 Few local studies focused specifically on patients’ nocturnal asthma symptoms. The National Health Survey in 2010 showed that 52% of local asthma patients had one episode of asthma symptoms in the 12 months before the survey, with 30% reporting symptoms that disturbed their sleep. 10 It is largely managed in the primary health-care system, served by dual providers in the public polyclinics and private general practitioner clinics. 8, 9Īsthma is also common in Singapore, affecting 10.5% of the adult population aged 18-69 years. 6, 7 Nocturnal asthma is thus often gauged by the presence of nocturnal asthma symptoms, which are probed by attending physicians or other health-care professionals, self-reported, or are incorporated as part of multi-faceted questionnaires to assess asthma control, such as the Asthma Control Test. 5 However, access to diurnal spirometry data for the diagnosis and management of nocturnal asthma is limited in many developing and even in some developed countries. Nocturnal asthma leads to a diurnal reduction in forced expiratory volume in one second (FEV 1) of more than 15%. Identifying patients affected by nocturnal asthma becomes a priority, as appropriate measures can be implemented to reduce their night-time symptoms. ![]() 4 Understanding and addressing these factors are prerequisites to the design of targeted interventions. 4 In the same review by William Calhoun, he also indicated that allergen exposure could also aggravate nocturnal asthma symptoms. However, the use of inhaled corticosteroid (ICS as controller medication) and long-acting β 2-agonist (LABA) have been shown to reduce their night-time symptoms and improve their psychometric outcomes, and quality of life. ![]() 3 Those affected by nocturnal asthma tend to cough, wheeze, have dyspnoea, be awakened at night, leading to high morbidity. 2 Nocturnal asthma is defined as night-time worsening of reversible airway disease associated with an increase in symptoms and airway responsiveness. 1 Approximately 47 to 75% of them report nocturnal symptoms. Globally asthma affects an estimated 300 million people. An increase in patients’ nocturnal symptoms was also predictive of the switching from ICS medications to combination formulations by their physicians. The risks of having nocturnal symptoms were primarily associated with those with allergic rhinitis. Nocturnal symptoms increased the odds (OR=2.87) of switching from inhaled corticosteroid (ICS) to combination medications (ICS-LABA (long-acting β 2-agonist)). The risks of nocturnal asthma symptoms increased over time for those with allergic rhinitis (OR=1.52) and reduced with subsequent visits (OR=0.91). The asthma action plan (AAP) status is significantly associated with nocturnal symptoms after adjusting for race, age and smoking status at baseline (odds ratio (OR)=0.49 (updated asthma action plan versus none), OR=0.37 (been-on plan versus none)). Having nocturnal asthma symptoms was significantly associated with the number of days with breathlessness, off usual activities and off work, and asthma severity at baseline (all P values <0.05). The generalised linear mixed-effects model (GLIMM) was used to model the primary and secondary outcomes. Association between nocturnal symptoms (defined as night-time cough, wheeze and breathlessness at least twice monthly) and each categorical predictor was tested. Patient clinical and therapeutic data were retrieved retrospectively from the programme’s database established in 2004. Methods:Ī longitudinal study was conducted on 939 multi-racial Asian patients with persistent asthma. It also studies the association between nocturnal symptoms and medication changes as the secondary outcome. This study primarily examines key factors predicting and mitigating nocturnal symptom risks among asthma patients, who were enrolled into a Singapore publicly funded asthma care programme. Nocturnal asthma symptoms result in poor quality of life and morbidity. ![]()
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