Q: “My son has asthma and will often have what appears to be a very serious episode in the middle of the night. After a nebulizing treatment, I can get him back to sleep and in the morning he appears to be just fine. What am I missing and can I do anything before he goes to bed to ensure that he sleeps through the night without incident?”

Martha White, MD: Asthma attacks in the middle of the night (nocturnal asthma) are a sign that asthma is not well controlled. Most people with asthma sleep without symptoms. When nocturnal asthma occurs more than twice a month, it’s time for an adjustment in your child’s preventive, anti-inflammatory medications.

I suspect that your child is having trouble with his asthma during the day as well. Look for signs such as coughing or stopping to rest more often than other children when he exercises. Perhaps this has been enough of a problem that he avoids exercise. Does he cough when he laughs or complain that his chest hurts? If any of these are happening more than twice a week, that’s also a sign that asthma is not well controlled.

During an asthma flare, nocturnal symptoms are common, and using a bronchodilator (albuterol, levalbuterol, ProAir® HFA, Ventolin® HFA, Proventil® HFA, or  Xopenex HFA®) prior to going to sleep often helps. However be sure to see his doctor to determine why he is having problems. If the symptoms really are occurring primarily at night, he may have trouble with gastroesophageal reflux, or he may have an allergen in the bedroom, such as dust mites or a beloved pet that’s triggering his asthma.

A board-certified allergist can help you sort out the possibilities and suggest avoidance techniques and treatment strategies, including adjusting medications if necessary.

Martha White, MD, FACAAI, is a board-certified allergist at the Institute of Asthma and Allergy in Wheaton, Md., a member of The Network’s Board of Directors, and an The Network medical editor since 1985.

Have a medical question? Email or write to Ask the Allergist, The Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.