September 30, 2002

MILWAUKEE (AAAAI) -- For children with mild-to-moderate asthma, waking up during the night could be a sign that their asthma is getting worse, according to a study in the September Journal of Allergy and Clinical Immunology (JACI). The JACI is the peer-reviewed, scientific journal of the American Academy of Allergy, Asthma and Immunology (AAAAI).

Whether a child wakes up at night from coughing, wheezing or having trouble breathing is an important indicator of the severity of their asthma. Robert Strunk, MD, Washington University School of Medicine, St. Louis, and colleagues followed 1,041 children with mild-to-moderate asthma for 28 days. In addition to recording how often they awakened at night, they assessed contributing factors, such as whether the child also had allergies, and how well-controlled their asthma was.

The study of 1,041 children showed:

• 351 children (34%) were awakened one or more nights because of their asthma. Overall, 870 awakenings occurred. Most children woke up once or twice during the 28 days, however a small number (2%) of the children had six or seven awakenings.
• The strongest risk factor for waking up at night because of asthma symptoms was having woken up in previous nights. Night awakenings within the previous 1 or 2 days increased the risk nearly 14-fold.
• Children with greater atopy (the genetic tendency to develop allergies or asthma) or who were clinically assessed as having more severe asthma were more at risk for awakening at night with asthma symptoms.
• Children with asthma who tested positive for allergies to dog or cat dander and who had those pets in the house, were more likely to wake up at night.
• Children whose asthma was considered unstable were more likely to wake up at night.

Based on all the observations, researchers concluded that asthmatic children most at risk for nocturnal awakening are those with poorly controlled asthma and those children with sensitivity to indoor environmental allergens (ie, cat and dog dander) to which they are exposed. Also, the presence of asthma symptoms at night could help identify children who are at risk for severe asthma exacerbations, and their asthma symptoms and treatment should be monitored closely.