Brittle asthma

https://doi.org/10.4081/monaldi.2007.497

Authors

  • O. Toungoussova Fondazione Salvatore Maugeri, Care and Research Institute, Cassano Delle Murge, Bari, Italy.
  • M.P. Foschino Barbaro Department of Respiratory Diseases, University of Foggia, Foggia, Italy.
  • L.M. Esposito Fondazione Salvatore Maugeri, Care and Research Institute, Cassano Delle Murge, Bari, Italy.
  • G.E. Carpagnano Department of Respiratory Diseases, University of Foggia, Foggia, Italy.
  • F.G. Salerno Fondazione Salvatore Maugeri, Care and Research Institute, Cassano Delle Murge, Bari, Italy.
  • R.W. Dal Negro Lung Department, Orlandy Hospital, Bussolengo, Verona, Italy.
  • A. Spanevello | aspanevello@fsm.it Fondazione Salvatore Maugeri, Care and Research Institute, Cassano Delle Murge, Bari, Italy.

Abstract

Brittle asthma is a clinical phenotype of the disease at the severe end of the spectrum. Type 1 brittle asthma is characterised by a maintained wide PEF variability (> 40% diurnal variation for > 50% of the time over a period of at least 150 days) despite considerable medical therapy including a dose of inhaled steroids of at least 1500 μg of beclomethasone or equivalent. Type 2 brittle asthma is characterised by sudden acute attacks occurring in less than three hours without an obvious trigger on a background of apparent normal airway function or well controlled asthma. Mechanisms behind the development of brittle asthma include smooth muscle contraction and edema of the airways, which are supported by chronic airway inflammation. Allergy reactions, impairment of local immunity, respiratory infections, psycho-social disorders and reduced perception of worsening airway function are the risk factors for brittle asthma. The diagnosis is based on the analysis of specific symptoms, role of triggers, personal or family history, measurement of lung function and PEF monitoring. Pharmacological treatment of type 1 brittle asthma in addition to the high doses of inhaled and/or oral steroids and bronchodilators includes subcutaneous injections of β2 agonist and inhalation of long acting β2 agonist. The treatment of patients with type 2 brittle asthma includes exclusion of allergen exposure, identification of triggers, self management and management of acute attacks.

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Published
2016-02-03
Info
Issue
Section
Reviews
Keywords:
Brittle asthma, severe asthma, peak expiratory flow
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How to Cite
Toungoussova, O., M.P. Foschino Barbaro, L.M. Esposito, G.E. Carpagnano, F.G. Salerno, R.W. Dal Negro, and A. Spanevello. 2016. “Brittle Asthma”. Monaldi Archives for Chest Disease 67 (2). https://doi.org/10.4081/monaldi.2007.497.

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