Patients with moderate to severe chronic airflow obstruction (COPD) are often affected by troublesome nighttime and early morning symptoms that include dyspnea (shortness of breath), cough, and excessive mucous production. These symptoms often follow the patient through the early morning hours. It is believed that these nighttime and early morning symptoms are due to deterioration in what is called respiratory mechanics during sleep. This theory is supported by studies demonstrating a reduction of airflow and dynamic hyperinflation at night. Hyperinflation is the trapping of air in the lungs because of narrowed airways and more rapid breathing. These problems and their associated symptoms occur most frequently between 2 and 6 am.

The current conventional way to help patients with these nighttime symptoms is the use of medications designed to open the airways, usually in inhaler form. Many of the new medications are used once daily and have been shown to provide relief for 24 hours; however, recent data suggests that using medications taken every twelve hours may have a more beneficial effect. Additionally, the use of pursed lip breathing, or the use of a training tool such as a pursed lip breathing device (PBD), prior to bedtime and with any awakenings may relieve symptoms.

Once daily inhalers may help patient compliance with therapy, but twice daily medications may provide some additional benefit, along with pursed lip breathing training. If you are experiencing increased nighttime or early morning symptoms discuss it with you lung doctor.