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Significance For centuries, it has been recognized that asthma severity shows a daily rhythm, with the worst symptoms at night. However, it is unclear to what degree this is driven by everyday behaviors, such as sleep, physical activity, and body posture changes, versus intrinsic rhythms generated by the internal body clock (i.e., the circadian system). To distinguish the contribution of the circadian system, patients with asthma underwent two complementary gold-standard circadian protocols: a constant routine and a forced desynchrony protocol. These highly standardized protocols revealed that the endogenous circadian system plays a significant role in modulating pulmonary function and asthma severity independent of sleep and other daily behavioral or environmental cycles. Moreover, these circadian influences summate with daily behavioral and environmental effects to drive asthma to be worst at night.

The endogenous circadian system worsens asthma at night independent of sleep and other daily behavioral or environmental cycles