The National Asthma Council has released a new resource for health professionals outlining key steps for treating patients who present with poor asthma control and sleep issues.
Associate Professor Greg Katsoulotos, Australian Asthma Handbook Committee member and respiratory medicine and sleep disorders physician, said the new resource was aimed at helping patients with asthma who report persistent night-time cough.
“Asthma symptoms during sleep or on waking indicate suboptimal asthma control and frequent nocturnal symptoms indicate increased risk of acute asthma exacerbations and should not be accepted as normal,” he said.
“The resource recommends that health professionals should consider stepping up asthma treatment with anti-inflammatory therapy in a patient with sleep disturbance due to asthma symptoms.”
According to Associate Professor Katsoulotos, nocturnal cough can occur with or without wheeze and can be a sign of poor asthma control that needs to be addressed with patients, who might think that their cough is due to an infection.
“Airway inflammation occurs in asthma, so treatment of airway inflammation is just as important as treatment of airway infection. If one or two courses of antibiotics do not help, consider that there may be unstable asthma or an alternative diagnosis.
“Inhaled anti-inflammatory therapy is the cornerstone of asthma treatment, not antibiotics or SABA alone,” he added.
The new sleep resource also highlights key asthma practice points and encourages the use of an asthma symptom tool such as the Australian Asthma Handbook Asthma Control Test.
The resource also aims to increase awareness of other causes of cough for people with asthma that may attract inappropriate use of oral steroids and multiple courses of antibiotics from misdiagnosis.
“Several conditions may contribute to both sleep disturbance and poorer asthma control, such as allergic rhinitis, obstructive sleep apnoea, gastro-oesophageal reflux disease and obesity and these should be investigated and managed simultaneously,” Associate Professor Katsoulotos said.
For example, in one recent case, a 17-year-old male presented as a very active young man playing professional sports, who started being troubled by night-time cough every night affecting his sleep, with fatigue, wheeze and loss of exercise tolerance.
Following three separate GP consultations, he was treated with multiple courses of antibiotics that didn’t help, but rather caused him gastrointestinal upset, and he was still unable to sleep or play soccer, being sent off the field. He was also given salbutamol reliever as needed, with little relief.
After weeks of ongoing sleep disturbance and inability to exercise, the patient and parents insisted on referral and lung function testing confirmed bronchodilator reversibility and high levels of airways inflammation, proving a diagnosis of asthma, as well as increased risk of asthma exacerbation.
Associate Professor Katsoulotos says he provided asthma education and introduced the patient to anti-inflammatory-reliever therapy, and the need to establish an asthma plan at his follow-up visit.
Treatment of the asthma rapidly resolved the patient’s cough, his energy returned and he was able to attend school, focus and play sport again. Since commencing anti-inflammatory-reliever therapy, the patient felt significantly better, could breathe, his coughing stopped and he slept for the first time throughout the night in almost four weeks.
Access the sleep and asthma information for health professionals here
