What is brittle asthma?
Who gets it?
What causes brittle asthma?
How do I deal with brittle asthma?
Conclusion
What is brittle asthma?
Brittle asthma is a little-known form of severe asthma. The symptoms are no different in type to ordinary asthma, but if you have a brittle asthma attack, it will be so severe that you will usually need to go to hospital and receive intensive medication.
There are two recognised types of brittle asthma:
Type 1 is marked by consistent wide variation in symptoms and peak flow readings, despite regular medication at high dose.
Type 2 appears to be well controlled between attacks. However, the attacks they do have seem to come on suddenly and may lead to unconsciousness.
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Who gets it?
About 1 in 2000 asthmatics has brittle asthma - about 1500 in Britain. The Type 1 pattern is more commonly seen in women and affects people aged 15 to 55. Type 2 is equally likely in males and females and the age pattern is similar to Type 1.
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What causes brittle asthma?
As with non-brittle asthma, there are multiple factors acting to produce these types. Many people do not take their treatment properly, although this cannot explain the underlying severe symptoms in the first place. Some also develop wheezing, which is probably associated with a hyper-responsiveness of the larynx (upper throat) to the same sort of triggers that lead to asthma.
Most Type 1 people are atopic - which means that airborne allergens in the home may be a factor. They are also more likely to be or have been cigarette smokers; psycho-social factors which contribute to their disease are also more common. In addition, most Type 1 people have an allergy to one type of food or drink, of which wheat and dairy products appear to be the most important.
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How do I deal with brittle asthma?
If your symptoms suggest you have this form of asthma then you must be assessed by a consultant respiratory physician with experience in severe asthma. This is not a condition to be managed solely by your GP. In general the treatment is the same as for ordinary asthma except that higher doses of drugs may be used. This often results in side-effects from oral steroid tablets, so your consultant may recommend steroid-sparing drugs.
In some people with Type 1 brittle asthma, subcutaneous beta-2 agonists (usually terbutaline) are helpful but this can only be started in a controlled way in hospital. All treatments have side effects and this is no different. The main problems are sore infusion sites and sometimes abcesses in the skin.
Those with Type 2 brittle asthma (and some with Type 1) should be provided with a MedicAlert bracelet, so that attending people can be alerted when they have an attack. One useful drug that can help in the rapid onset attacks seen in Type 2 people is injected adrenaline from a pre-loaded syringe, although any such use should always lead to hospital attendance as adrenaline may only buy time on some occasions.
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Conclusion
Brittle asthma is just one form of severe asthma. People with it often feel frightened and isolated and may benefit from psychological support from their respiratory nurse or respiratory hospital unit. It is essential that any such people be managed by a combination of primary and secondary care, with the hospital taking the lead.
