Severe and sudden respiratory condition that, although needing aggressive and urgent treatment, has not progressed to irreversible hypoxia and cardio-pulmonary arrest.
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.
Sudden and rapid in onset
Dyspnea, paradoxical breathing, lightheadedness
Physical exhaustion leading to increased work of breathing
Failure of standard asthma therapy
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)