1. To investigate the role of mast cells and eosinophils in the pathogenesis of nocturnal asthma, the plasma methylhistamine concentration, serum eosinophil cationic protein level and peak expiratory flow rate were measured 2-hourly for 24 h in 10 patients with nocturnal asthma and in 10 healthy control subjects. Nocturnal asthma was defined as at least one nocturnal awakening per week due to cough, wheeze or breathlessness with an average overnight fall in peak expiratory flow rate of at least 15% during a 2-week run-in period.
2. The lowest peak expiratory flow rate occurred at 02.00–04.00 hours in the group with nocturnal asthma, whose overnight fall in peak expiratory flow rate was 29 ± 5% in comparison with 5 ± 1% (means ± sem) in the normal subjects.
3. Plasma methylhistamine levels at night (0.200–04.00 hours) were lower than during the day (10.00–20.00 hours) in both asthmatic patients and normal subjects (asthmatic patients: day, median 0.22 ng/ml, 95% confidence intervals 0.18–0.34 ng/ml; night, 0.17 ng/ml, 0.13–0.24 ng/ml; P<0.01; normal subjects: day, 0.31 ng/ml, 0.24–0.41 ng/ml; night, 0.24 ng/ml, 0.21–0.33 ng/ml; P<0.01).
4. The serum eosinophil cationic protein level was higher by day (30 ng/ml, 8–47 ng/ml) than by night (21 ng/ml, 5–34 ng/ml; P<0.04) in the group with nocturnal asthma, but did not change significantly with the time of day in the normal subjects (day: 8 ng/ml, 4–14 ng/ml; night: 8 ng/ml, 5–21 ng/ml).
5. Peripheral blood eosinophil counts fell in the early morning in the patients with nocturnal asthma (day: 0.52 × 109/l, 0.14–0.76 × 109/l; night: 0.29 × 109/l, 0.13–0.57 × 109/l; P= 0.03), but did not change significantly in the normal subjects.
6. This study indicates that a rise in plasma histamine concentration is not a prerequisite for nocturnal asthma.
Incidence of acute decreases in peak expiratory flow following the use of metered-dose inhalers in asthmatic patients