New resource to help asthma patients sleep well

The National Asthma Council Australia (NAC) has released a new health professional resource to help treat patients who present with poor asthma control and sleep disturbance. The new 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.

Associate Professor Greg Katsoulotos, Australian Asthma Handbook Committee member, said the new resource is valuable for health professionals when patients with asthma report persistent night-time cough. Katsoulotos said the new 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.

“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,” Katsoulotos said.

Nocturnal cough can occur with or without wheeze and can be a sign of poor asthma control that needs to be addressed with the patient who may instead think that their cough is due to an infection. According to Katsoulotos, airway inflammation occurs in asthma, so treating airway inflammation is just as important as the 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,” Katsoulotos said.

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,” Katsoulotos said.

Associate Professor Katsoulotos said a recent patient, 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, with fatigue, wheeze and loss of exercise tolerance. After three separate GP consultations, he was treated with multiple courses of antibiotics that didn’t help but rather caused gastrointestinal upset and he was still unable to sleep. 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 a referral, and lung infection testing confirmed bronchodilator reversibility and high levels of airway inflammation, confirming a diagnosis of asthma as well as increased risk of asthma exacerbation.

Katsoulotos provided asthma education and introduced the patient to anti-inflammatory-reliever therapy, and established an asthma plan at his follow-up visit. The treatment of the asthma rapidly resolved the patient’s cough, his energy returned and he was able to attend school and play sport again. Since commencing anti-inflammatory-reliever therapy, the patient’s condition has improved; he can breathe, his coughing has stopped and he has slept for the first time throughout the night in almost four weeks.

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