Book Review

Nocturnal Asthma: Mechanisms and Treatment

N Engl J Med 1994; 330:1396May 12, 1994

Article

Nocturnal Asthma: Mechanisms and Treatment
Edited by Richard J. Martin. 394 pp., illustrated. Mount Kisco, N.Y., Futura, 1993. $72. ISBN: 0-87993-546-4

Worsening of asthma at night has been recognized since the earliest descriptions of the disease, but the mechanisms underlying this phenomenon have still not been fully explained. Nocturnal exacerbation is a very common feature of asthma. It may affect a large proportion of patients and is often unrecognized by doctors. Although it has been neglected by researchers for many years, there has been increasing interest in the phenomenon of nocturnal asthma over the past decade, for several reasons.

First and foremost, nocturnal asthma remains an important clinical problem, and patients with asthma are often troubled by nighttime symptoms even when asthma is well controlled during the day. Second, the worsening of asthma at night is a clue to the factors that worsen asthma in general. The fact that nocturnal asthma occurs naturally and regularly provides researchers with a valuable model, although the fact that measurements have to be made in the middle of the night has deterred all but the most dedicated investigators. Third, nocturnal asthma is partly explicable by circadian rhythms and provides insights into the mysterious worlds of chronobiology and chronotherapeutics. The temporal factors in disease and in therapy have largely been neglected by the medical profession, yet there are important reasons why this fledgling science should command more attention.

In Nocturnal Asthma, Richard Martin of the National Jewish Center for Immunology and Respiratory Medicine in Denver has attempted to bring together all the research on nocturnal asthma. The book is made up of a series of chapters on different aspects of nocturnal asthma, written predominantly by Martin's colleagues in Denver. Two introductory chapters on chronobiology present a useful overview of the importance of intrinsic biologic rhythms in physiology and disease and discuss concepts in chronopharmacology and chronotherapeutics. Much of the work in this field is descriptive, and there seems to be little understanding of underlying mechanisms. The importance of temporal factors in pharmacokinetics and pharmacodynamics needs to be stressed, however; nocturnal asthma is a good example of how this knowledge may be applied.

A review of the underlying mechanisms and treatment of nocturnal asthma by Martin covers most of the important information subsequently discussed in greater detail in succeeding chapters. Each chapter is well written and comprehensive, but there is a restricted amount of information, based on a limited number of studies, so it is inevitable that there will be repetition. The chapters are well illustrated with figures (although simple graphs sometimes take up a whole page).

Overall, this is a useful book that provides up-to-date coverage of nocturnal asthma, with valuable references. Much of the information here is already available in recent reviews and journal supplements. A major disadvantage of specialized books such as this one is that they rapidly become dated, and indeed there are few references here after 1990. This is a general problem, however, in rapidly advancing areas of research. The book will be a useful addition to libraries and valuable to a small group of researchers in the field, but it is unlikely to have widespread appeal because of the specialized nature of the topic.

Peter J. Barnes, D.M., D.Sc.
National Heart and Lung Institute, London SW3 6LY, United Kingdom