Brittle asthma

People with asthma usually experience inflammation and narrowing of the airways, making it difficult for them to get air into their lungs.

In relapsing asthma, symptoms are severe, often persistent, sometimes out of nowhere, and can be life-threatening.

In this article, we look at the causes, symptoms and treatment of asthma exacerbations.

Causes and Risk Factors

Collapsing asthma is rare. Doctors aren’t entirely clear why some people develop asthma attacks, but certain factors increase a person’s risk of the condition.

Some research suggests that asthma exacerbations are related to food intolerances. Cited research shows that about 60% of people with type 1 asthma have food intolerances, including about 50% who have intolerances to wheat and dairy products.

Mental health may also play a role in the severity of asthma exacerbations.

A review study analyzed 5510 articles that looked at psychosocial factors and asthma management. The findings indicated that asthma and mental health may interact and ultimately control a person’s asthma symptoms.

Having certain other medical conditions can also contribute to the risk of severe asthma, including:

  • gastroesophageal reflux disease
  • obstructive sleep apnea
  • sinusitis

Additional risk factors for developing brittle asthma include:

  • obesity
  • deficiency of antibodies
  • cigarette smoking
  • frequent respiratory infections
  • exposure to allergens

Types of Brittle Asthma

Experts further classify asthma as type 1 or type 2, both of which have severe symptoms including:

Type 1

Type 1 asthma refers to people who have a large difference in peak expiratory flow rate (PEF). PEF measures how fast a person can expel air from the lungs in liters per minute immediately after taking a full breath.

PEF measurement is an indicator of the severity of asthma symptoms. When a person has type 1 asthma, their PEF measurements can be widely inconsistent despite treatment with inhaled corticosteroids.

Type 2

Sometimes, people can control type 2 asthma with traditional medications for a long time. However, type 2 relapsing asthma is unpredictable, and some people may have severe asthma attacks.

People who have severe attacks may need treatment with a mechanical ventilator to help them breathe. In some cases, the attacks are fatal.

Symptoms of Brittle Asthma

The symptoms of fulminant asthma are more severe than those of normal asthma. Symptoms may also persist.

In many cases, people with asthma attacks may need to be hospitalized. Difficulty breathing can be life-threatening.

Symptoms of fulminant asthma may include:

  • Severe shortness of breath
  • Significant chest tightness
  • wheezing
  • Cough

How Common is This?

Asthma is a common condition. According to the World Health Organization, around 235 million people worldwide suffer from asthma.

Most people with asthma have a mild form. However, according to some estimates, 5-10% of people with asthma have a severe form of the disease. Of these, about 0.05% of people with asthma develop an asthma attack.


People with asthma attacks often need to go to their doctor’s office or emergency room. A doctor will make a diagnosis based on a medical history review and physical examination, as well as the severity and frequency of a person’s asthma symptoms.

Doctors use tests to measure the severity of asthma. These include pulmonary function tests and PEF measurements. They may also recommend a plain-film chest X-ray or CT scan to help them rule out other respiratory conditions that could cause similar symptoms.

Treatment and Management

Some doctors find brittle asthma challenging to treat, which is why it may become life-threatening.

Proper treatment and management involve more than the routine bronchodilator and corticosteroid inhaler therapies that work for other types of asthma. Usually, it takes a little trial and error for a person to get brittle asthma under control.

A doctor will need to monitor a person’s symptoms closely and their response to treatment to determine the most effective strategies for keeping symptoms at bay.

Treatment for brittle asthma may include the following:


Medications play a major part in a treatment plan for brittle asthma. However, most treatment approaches are not specific to brittle asthma. Instead, doctors use them to treat all forms of severe and uncontrolled asthma.

Medications to treat brittle asthma may include:

  • Steroids. Although steroids are not always effective for people with brittle asthma, high doses may help. In addition to higher doses of inhaled steroids, people might also use oral steroids, such as prednisone.
  • Anticholinergic agents. These drugs relax the muscles of the airway to help control asthma and reduce severe symptoms. Spiriva (tiotropium) is an example of a long-acting maintenance anticholinergic medication.
  • Leukotriene antagonists. Leukotrienes are chemicals released by cells and tissues in the immune system. They play a role in inflammation, allergy, and asthma symptoms. Leukotriene antagonists decrease the action of leukotrienes by blocking them at their receptors, which may reduce asthma symptoms over the long-term.
  • Beta-2-agonists. People can use both short-acting and long-acting beta-2-agonists in the form of inhalers and liquid for a nebulizer. Beta-2-agonists relax and open up the airway muscles, improving breathing.

Bronchial Thermoplasty

Inflammation due to asthma may thicken the smooth muscles in the airway. Bronchial thermoplasty involves delivering radio frequency energy to the smooth muscles of the airways to decrease thickness.

The U.S. Food and Drug Administration (FDA) has approved bronchial thermoplasty to treat severe asthma in adults. Researchers have not focused their studies on bronchial thermoplasty specifically to treat brittle asthma.

Reducing Allergens

Brittle asthma

It is a good idea for people with brittle asthma to try to reduce their exposure to allergens.

Common allergens include:

  • cockroaches
  • pet dander
  • mould
  • pollen

Vacuuming with a HEPA filter, dusting often, and using an exhaust fan in the bathroom can help.

Omalizumab Injections

Omalizumab contains recombinant anti-immunoglobin E monoclonal antibody, which helps reduce the allergic response that may cause persistent asthma symptoms. Having an under the skin injection once or twice a month may help prevent asthma attacks.

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