Severe and sudden respiratory condition that, although needing aggressive and urgent treatment, has not progressed to irreversible hypoxia and cardio-pulmonary arrest.
Classification
Brittle asthma:
Asthma with dramatic fluctuations in daily PEFR despite oral corticosteroids
- Type I: Characterized by wide swings in peak expiratory flow (PEF) despite maximal therapy.
- Type II: Characterized by very sudden attacks.

Pathophysiology

Clinical features
-
Sudden and rapid in onset
-
Dyspnea, paradoxical breathing, lightheadedness
-
Physical exhaustion leading to increased work of breathing
-
Failure of standard asthma therapy
-
Hypoxemia
-
Respiratory arrest
-
Death
Management
Type I brittle asthma:
- Oral corticosteroids or continuous subcutaneous infusion of terbutaline (or salbutamol))
- Dietary exclusion of allergic foods
Type II brittle asthma:
Difficult to manage because they do not respond well to corticosteroids and inhaled bronchodilators.
- Self-administered subcutaneous adrenaline (to abort the rapidly developing exacerbations)