Coughing worse at night and in bed: Why asthma symptoms are worse in the evening

Coughing, shortness of breath, a tight chest, wheezing and other asthma symptoms are more likely to develop in the evening and at night than during the day. This can lead to sleeplessness and can be very difficult for those affected. In an interview, pulmonary specialist Prof Dr Rainald Fischer explains the phenomenon and shows what people with asthma can do against coughing and shortness of breath in the evening.

PARI blog: Prof Dr Fischer, why is coughing and shortness of breath worse in the evening and at night than during the day for asthmatics?

Prof Dr Fischer: The reason for the bad cough, breathing problems and tendency to asthma attacks in the evening is what is known as the circadian rhythm – i.e. the natural day and night rhythm. Cortisol and histamine release in particular is affected by circadian fluctuations. In the evening, the body naturally produces less cortisol and histamine.

This means inflammation is more likely to develop in the evening and at night, which in turn causes the lining of the bronchial tubes to swell. This means that the bronchial tubes are naturally narrower in the evening than during the day and so asthma problems are more likely to arise.

PARI blog: Are there other causes aside from the day and night rhythm that make asthma symptoms more severe in bed?

Prof Dr Fischer: When we lie down, secretions from the nose and sinuses flow towards the airways, which can trigger a cough as a protective reflex. The cough stops the nasal secretions reaching the lungs, so it is a positive response, but can still be a nuisance. The horizontal position also means that the lungs have less room to expand, which can also affect the ability to breathe.

If you have a dust or dust mite allergy, this can trigger allergic asthma, because our bedding harbours dust mites. When you lie down at night and are closer to these allergens, it can worsen the symptoms.

PARI blog: What can people with asthma do against the evening and night-time cough?

Prof Dr Fischer: The most important thing is to take your medication as prescribed. If your symptoms still increase in the evening and at night, it is really important to talk to your doctor to see if your asthma medication needs to be adjusted. Of course, it is important to avoid asthma triggers – regularly change your bedding and clean your bedroom to reduce levels of dust and dust mites.

If the asthma is triggered by a pollen allergy, it is important to air your home at the right time of day. It may also be worth setting up a pollen filter in the bedroom which will filter the pollen out of the air. Everyone – not just the person affected but also their partner – should take off clothes contaminated with pollen outside the bedroom. It can also help if you wash your hair to remove the pollen. The aim is to reduce allergens as far as possible.

If you have a runny nose or lots of nasal secretions, it can help to do a nasal douche before you go to bed. Generally, if you are affected by this you should get to know how your body works. Keeping a diary to identify triggers of which you are not yet aware, can help. You should discuss your observations with the doctor.

PARI blog: Prof Dr Fischer, thank you very much for taking the time to talk with us.

About Prof Dr Rainald Fischer

Prof Dr Rainald Fischer is a specialist for internal medicine in private practice, with a subspecialty in lung and bronchial medicine, specialty of emergency medicine, sleep medicine and allergy medicine in Munich-Pasing. Before that he worked as an internist and lung specialist, most recently as a senior physician at the Munich university hospital. Prof Dr Rainald Fischer is a founding member and president of the Deutschen Gesellschaft für Berg- und Expeditionsmedizin (German Society for Mountain and Expedition Medicine), and also a member of the Cystic Fibrosis Medical Association.

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Note: The information in this blog post is not a treatment recommendation. The needs of patients vary greatly from person to person. The treatment approaches presented should be viewed only as examples. PARI recommends that patients always consult with their physician or physiotherapist first.

An article written by the PARI BLOG editorial team.

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