Is it true that asthma gets worse at night? Find it out!

People with asthma, a common chronic disease that affects the airways, have their worst attacks at night, and scientists are still trying to figure out why. The disease is the closing of the air passage, which results in difficulty in breathing. As a consequence, the patient also starts to feel a constant pain in the chest, the breath becomes wheezing and then comes an intense cough.

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Over the past few centuries, researchers have found that, in fact, the worst attacks happen at night, with the probability of being the most fatal. However, none of them came to a concrete answer as to why this happened. Among the hypotheses are the position in which the body is at night, allergenic substances in bed, and the biological clock itself. The latter is the most interesting and the one that motivated a recent study conducted by physician Frank Scheer, in the United States.

The biological clock is also known as the circadian system, responsible for regulating hormones, the heartbeat and the immune system in cycles of 24 hours. Even in the case of an internal system, external factors can affect its operation, such as working hours and meals, day and night, among others. Isolating the circadian system from these external factors for conducting research, however, was virtually impossible. Until then.

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Image: Reproduction/Twenty24photos/Envato Elements

Tests

Scheer and his team found a way to separate the external issues that can contribute to the worsening of asthma attacks, reaching interesting results. In the study, participants diagnosed with asthma tracked their lung functions at home , while living life normally. The analysis was performed four times a day with the help of a portable spirometer, a device that measures the amount of air that is expelled from the lungs in one second.

Participants also needed to record their seizure symptoms every time they needed to use inhalers. Later, the study evolved and required two different experiments with the same group, who had to stay at the study site, Brigham and Women’s Hospital, in a dark room. In the first one, they stayed in a bed for 24 hours and couldn’t sleep, just get up for use the bathroom, do activities and eat every two hours only with tuna or peanut butter sandwiches. The activities needed to be light, without them having to move and not causing excitement or anger.

“The constant routine protocol is based on the concept that you remove any rhythmicity from

hours and any factors, environmental or behavioral, that may induce changes in physiology”, says the study leader. To analyze the results, the volunteers were connected to thermometers that continuously measured the core temperature. Every four hours, the nurses collected blood and urine, tested breathing with a spirometer and measured airway resistance, which may indicate the existence of swelling or accumulation of mucus.

In the last test phase, the forced dyssynchrony protocol was applied. The participants remained in low light conditions for eight days, living cycles of 24 hours instead of 20 hours, with permission to sleep, shower and eat. They could move a little more than in the previous protocol, but were not allowed to go outside or do more intense exercise. Participants also underwent airway exams every two or four hours.

Image: Reproduction/Freepik

Result

At the end of the three experiments, the scientists discovered that the circadian rhythm actually contributes to the worsening of asthma . Overnight, the researchers reported that when participants’ biological clocks understood that it was time for bed, they were four times more likely to use inhalers. In addition, participants who had increased lung function during the day also had more airway resistance at night and less satisfactory results with the spirometer. And when sleep coincided with the night, airway resistance was greater.

Therefore, the conclusion says that the circadian rhythm affects asthma, regardless of behavior and whether the person is asleep or awake. The behaviors, however, can affect the frequency and severity of attacks, as the biological clock never works alone and will always be affected by light, sleep cycles, work schedules, exercise and meals. What is not clear is how the circadian system worsens asthma, but there are some new hypotheses.

Researchers believe that it is the influence of cortisol, a hormone that is strongly regulated by the circadian system and that it is triggered by stress. Cortisol levels are reduced at night, while rising in the morning, causing more glucose to be released into the bloodstream to prepare the body for daily activities. Thus, with the reduction of the hormone at night, lung function is also reduced.

Scientists also attribute the possibility that the cycle is affected by melatonin, which increases as we become more sleepy and , consequently, contributing to the activity of the lungs. There is also a chance of aggravation by the autonomic nervous system, which is responsible for controlling the involuntary movements of the body, such as heartbeats, which are also connected to the circadian rhythm.

It is also not known if there is a connection between the brain and asthma in the suprachiasmatic nucleus, which controls the circadian rhythm. But scientists have found that lung cells have autonomous molecular clocks and are possibly involved in regulating lung function. With the results of the experiments, the researchers found that they still have a lot of work to discover the causes and possible treatments.

You can check the study at this link.

Source: Wired

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