Asthma attacks in the middle of the night can be a real headache. Not only is it painful for the patient, but it is also unsettling for the family. According to statistics, more than 90% of patients have experienced this painful experience, especially among children, nighttime asthma attacks are a common occurrence. In some patients, the symptoms are still mild during the day, but in the middle of the night, the symptoms increase significantly and the asthma attacks force the patients and their families to go to the hospital emergency room, thus becoming a regular visitor to the hospital emergency room in the middle of the night. Statistics show that of the 8,000 cases of asthma, 39% of patients have an attack every night, 64% have at least 3 attacks per week at night, and 74% have 1 attack per week at night. Moreover, 70% of asthma attacks resulting in death occur at night. Nocturnal attacks or exacerbations of bronchial asthma in patients occurred mostly between 10 pm and 7 am, most often at 4 am, and this phenomenon was more common in chronic asthmatics than in paroxysmal ones. Therefore, active treatment of nocturnal asthma is an important part of asthma control. A. Asthma patients should understand the factors associated with asthma attacks at night to facilitate the treatment of asthma: 1. Allergen factors: exposure to allergens is the main cause of asthma in bronchial asthma patients, but asthma does not occur immediately after exposure to allergens, and asthma attacks generally start only after 6-8 hours of exposure. So less exposure to chemicals during the day can reduce asthma attacks at night. 2, physiological rhythm factors: lung function is relatively strong during the day and relatively weak at night, and the anti-allergic ability is significantly reduced, resulting in asthma attacks easily at night. Taking long-acting anti-allergy drugs before going to bed can prevent asthma attacks at night. 3, temperature change factors: a 0.7 degree drop in body temperature during sleep can cause bronchoconstriction, thus triggering an asthma attack, while sleeping in a warm environment can significantly reduce nighttime asthma attacks. 4, sleep position factors: sleep supine position when the respiratory resistance of the trachea increased significantly, prone to apnea phenomenon, due to lack of oxygen caused by bronchospasm, resulting in asthma attacks. Side lying position can prevent or reduce asthma attacks. 5. Gastroesophageal reflux factor: At night when sleeping, because of the position, food or gastric juice of the stomach may reflux into the esophagus, which in turn may be inhaled into the trachea due to respiration, causing bronchial spasm. 90% of asthma patients with adult onset have gastroesophageal reflux symptoms, and these patients need to be treated for “stomach problems” to relieve asthma. 6, inflammatory factors: most asthma patients have sinusitis or bronchitis. At night, the secretion of sinusitis increases, and the inflammatory response of the airways is heavier. This is also the cause of asthma attacks. The use of antibacterial drugs to treat sinusitis and bronchitis is one of the important measures to prevent asthma. 7. Environmental factors in the bedroom: Generally speaking, the air is drier at night than during the day, and dry air can induce bronchospasm and make asthma attacks. Increase the indoor humidity, or drink a glass of plain water before going to sleep, has the effect of preventing asthma attacks at night. In addition, burning a briquette stove at night produces sulfur dioxide, which stimulates the airways due to closed doors and windows, poor indoor ventilation, and increased concentration of carbon dioxide in the indoor air. In addition, newly painted furniture and newly decorated rooms can also emit certain harmful gases. Second, how to treat asthma at night? 1. Stop airway constriction at night. The use of drugs to dilate the airway and stop airway smooth muscle contraction and spasm is an effective means to control nighttime asthma attacks. In the past, aminophylline was mostly taken at bedtime to control asthma, but its half-life is short and the efficacy is not satisfactory. In recent years, the advent of long-acting β-2 agonists and theophylline-modified controlled-release tablets has solved this problem. The efficacy of these drugs can be maintained for more than 12 hours with a single dose. Clinical studies have shown that long-acting β2 agonists and theophylline controlled-release tablets have similar efficacy in controlling nocturnal asthma symptoms. However, many foreign studies in recent years have shown that increased asthma mortality is associated with increased use of β2 agonists, and that long-term use of β2 agonists can lead to deterioration of lung function. 2.Reducing airway inflammation and reducing airway reactivity. Chronic airway inflammation is the essential feature of asthma. Asthma patients have enhanced airway inflammatory activity at night. Anti-inflammatory treatment can reduce airway inflammation, decrease airway hyperresponsiveness and stop asthma attacks. Glucocorticoids are the most effective drugs for eliminating airway inflammation, with good efficacy and few side effects when administered by inhalation. Inhaled glucocorticoids are more effective than long-acting β2 agonists in controlling nocturnal asthma. Generally, Andersen or Bicodone can be used for inhalation, and the specific dose can be adjusted according to the condition. 3. Inhibit gastroesophageal reflux. Although the relationship between nocturnal asthma attacks and gastroesophageal reflux is still controversial, at least some patients have nocturnal asthma attacks related to it. Most of these patients have esophageal hiatal hernia. The use of theophylline drugs may also increase the likelihood of gastroesophageal reflux by relaxing the lower esophageal ring. Intraesophageal pH and pulmonary function measurements are the best methods to help make the diagnosis. The main therapeutic measures include frequent meals, no medications and beverages between meals especially at bedtime, no fatty foods, alcohol, theophylline drugs, β2 agonists, use of H2 receptor antagonists and drugs that increase lower esophageal pressure such as metformin and ura choline, and elevated head position during sleep. In patients with severe nocturnal asthma for which drug therapy is ineffective, surgical treatment is feasible. 4. Eliminate paranasal sinus inflammation. Studies have shown that about 70% of asthma patients have combined paranasal sinus inflammation, and treatment with antibiotics is associated with a reduction in asthma severity. The course of antibiotics should be more than 3 weeks, together with nasal irrigation, nasal decongestion and local corticosteroids. Individual patients need surgical treatment. 5. Prevention and control of allergic factors. Some asthma patients have nocturnal attacks related to exposure to indoor allergens. Common indoor allergens include dust mites, dust, animal fur and secretions, perfumes, air fresheners, hairspray, etc. Some studies have shown that asthma patients exposed to allergens in the evening, the incidence of late asthma reactions up to 90%, and the degree of heavy, long duration. The main prevention and control measures are: 1.Search for allergens through allergen skin test, specific immunoglobulin test, allergen screening and other methods. 2, improve the living environment is a simple and easy way to reduce allergens. Remove identified or suspected allergic factors, such as no carpeting, keep the room clean, use acaricidal drugs, etc. 3. Specific desensitization treatment can be used for those with clear allergens and poor results of other treatments. It should be emphasized that both specific desensitization and anti-inflammatory treatment have the problem of maintenance treatment, that is, long-term use of drugs. If the treatment is terminated without authorization, the previous work may be lost.