Brittle asthma is a rare, severe form of asthma. Sufferers experience the same symptoms that affect all asthmatics, including wheezing, coughing, and difficulty breathing, but the symptoms are much harsher, tend to come on suddenly and unpredictably, and are often resistant to traditional medications. There are two varieties of brittle asthma, Type 1 and Type 2.
Type 1 brittle asthma is characterized by chronic symptoms that affect sufferers on a daily basis. Patients are typically on high doses of daily medication to control their asthma, as regular doses are ineffective. The ongoing nature of their problem often limits their ability to perform normal day-to-day tasks, making it very difficult and frustrating to cope with. In addition to their chronic condition, they usually suffer from periodic severe attacks that come on with almost no warning. These patients often require hospitalization to bring their breathing problems under control, either from an acute attack or because their overall condition degrades significantly over a period of time.
For those with Type 2 brittle asthma, their symptoms are fairly well controlled most of the time. What sets them apart from regular asthma patients are unexpected, abrupt attacks with extremely intense symptoms, similar to those that affect Type 1 sufferers. Often these occasions are severe enough to be life-threatening and generally require hospitalization.
Treatment for this condition normally involves the same medications used for regular asthma, but often much more of it is required than in normal cases. Fast-acting bronchodilators are used for quick relief, and steroids, corticosteroids, and slow-release bronchodilators are used for long-term management. Brittle asthma patients may use special methods of delivery, such as nebulizers or subcutaneous injections, to accommodate the larger doses of their medications. Type 2 patients may also use strategies to try to limit their severe attacks, such as avoiding allergens and other triggers.
Once an attack has progressed to the point that hospitalization is necessary, patients need to be treated quickly and aggressively, as the condition is potentially fatal. Steroids and other medications will often have to be administered intravenously to help control symptoms. Patients who do not respond significantly to medication may require a ventilator to get extra oxygen. Blood gases and oxygen should be monitored until they come back to normal. The patient's overall status needs to be evaluated to determine if he or she can safely be discharged and manage his or her asthma at home.
