Abstract
Asthma is recognised as a heterogeneous disease and, within this heterogeneity, brittle asthma is identified as a distinct phenotype. Two types of brittle asthma have been recognised in adults: type 1, showing more than 40% diurnal variability in PEF rate on most days over long periods and type 2, with acute severe attacks on a background of apparently good asthma control. The exact incidence of these phenotypes in adults is unknown but both seem to carry an increased risk of death and considerable morbidity. Adults with brittle asthma are generally atopic, with a high degree of psychosocial morbidity. This phenotype has not been recognised to the same degree in children, although we believe that such children exist and probably present the same management problems as their adult counterparts. The management of brittle asthma is, as for all patients with complex disease, holistic, with the removal of important causal factors ensuring compliance and providing adequate education. Steroid therapy remains the mainstay of treatment but the balance has to be struck between the benefits and side-effects of both inhaled and oral corticosteroids. Continuous subcutaneous terbutaline has been shown to be effective in controlling PEF varia...Continue Reading
References
Apr 1, 1977·British Journal of Diseases of the Chest·M Turner-Warwick
Jun 1, 1992·Archives of Disease in Childhood·T K Ninan, G Russell
Mar 1, 1990·Thorax·E A MitchellP T White
Oct 1, 1988·British Journal of Diseases of the Chest·B R O'DriscollG M Cochrane
Jan 1, 1985·Archives of Disease in Childhood·F Carswell
Jun 9, 1984·British Medical Journal·J AyresC Skinner
May 13, 1995·Lancet·I P HallS B Liggett
May 1, 1993·Thorax·G M Garden, J G Ayres
Nov 1, 1995·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·J MilesJ Ayres
Apr 1, 1997·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·R M Sly, R O'Donnell
Oct 24, 1997·Respiratory Medicine·J G Ayres, R A Thompson
Dec 31, 1997·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·J F MilesJ G Ayres
Feb 14, 1998·BMJ : British Medical Journal·B KaurJ O Warner
Sep 19, 1998·Thorax·J G AyresP J Barnes
May 8, 1999·The European Respiratory Journal·W S TunnicliffeJ G Ayres
May 18, 1999·Thorax·J C BakerJ G Ayres
Oct 20, 1999·Thorax·T P Ng, W C Tan
Mar 14, 2001·Thorax·P V Dicpinigaitis
Apr 20, 2001·Thorax·D N PayneA Bush
Sep 11, 2001·American Journal of Respiratory and Critical Care Medicine·A ten BrinkeE H Bel
Apr 12, 2002·Pediatric Pulmonology·Donald N R PayneMark Rosenthal
Jul 4, 2002·Thorax·J DouwesN Pearce
Citations
Mar 8, 2013·The Nursing Clinics of North America·Catherine Casey S JonesMolly A Martin
Aug 30, 2012·Clinics in Chest Medicine·Isabelle Tillie-LeblondJacques de Blic
Dec 29, 2009·Annals of Epidemiology·Kari HemminkiKristina Sundquist
Dec 13, 2007·The Journal of Allergy and Clinical Immunology·Stephen T Holgate
Sep 4, 2015·International Forum of Allergy & Rhinology·K Christopher McMains
Feb 3, 2011·Annals of Medicine·Kari HemminkiKristina Sundquist
Jan 23, 2008·Allergology International : Official Journal of the Japanese Society of Allergology·Stephen T Holgate
Dec 3, 2014·The Journal of Allergy and Clinical Immunology. in Practice·Michael Schatz, Lanny Rosenwasser
Feb 4, 2014·Clinical Reviews in Allergy & Immunology·Alexander Wade, Christopher Chang
May 14, 2010·Current Opinion in Pharmacology·Rafael Firszt, Monica Kraft
Sep 10, 2015·Scientific Reports·Kari HemminkiJianguang Ji
Nov 3, 2010·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Bruno MahutChristophe Delclaux
Dec 18, 2020·Journal of Applied Physiology·Kris NilsenFrancis Thien