Nocturnal asthma and changes in circulating epinephrine, histamine, and cortisol.

NOCTURNAL and early morning wheezing is very common in asthmatics, 1–3 but the mechanisms are far from clear. The clinical importance of this symptom is underlined by the fact that many sudden deaths from asthma and many episodes of ventilatory arrest occur in the early morning.4 , 5 Several mechanisms have been proposed to explain nocturnal wheezing. There is little evidence that allergic factors such as house-dust mites in bedding have a major role, 6 and the same pattern of airway obstruction is observed in patients with nonatopic (intrinsic) asthma.3 Neither the supine posture nor sleep patterns appear to be important, and sleeping itself . . .

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