What does this form of asthma really mean?

Symptoms of Brittle Asthma
The Main Differences between Regular and Brittle Asthma
Treatments for Brittle Asthma
The Treatment of Brittle Asthma in Hospital

There is much written information on asthma, but only very little about brittle asthma which is a rare and sometimes severe form of asthma which can threaten the independence of individuals, their day to day life and their confidence as well as being life-threatening at times!

Symptoms of Brittle Asthma

All asthma sufferers have inflamed and constricted airways which cause a tightness in the chest as well as difficult breathing. These symptoms in brittle asthma sufferers are often chronic, severe and very difficult to treat as well as proving unresponsive to medicines and other treatments. Brittle asthmatics are also very susceptible to sudden and often unpredictable changes in their condition, and this is where the term 'brittle' is used.

Sufferers can fall into the following categories:

• Type 1 Brittle Asthmatics suffer chronically every day with their asthma, even though they are on large amounts of medication and treatment and this often includes the use of daily steroids. Apart from their chronic daily condition, they can sometimes suffer life- threatening asthma attacks which come on suddenly and often with little or no warning. Type 1 sufferers may need frequent admission to hospital when their condition is exacerbated. They may try to lead as normal a life that is possible, but many find themselves unable to work and in some cases become registered disabled.



• Type 2 Brittle Asthmatics often appear to be reasonably well with their asthma well controlled, but the Type 2 sufferers can also have severe and often life threatening attacks that come on very suddenly with little or no advanced warnings and they too may require frequent hospital admission. These asthmatics may have access to high doses treatments in an emergency when their condition worsens, some may take steroids every day in short courses, but most of the time their condition is kept stable by regular medication and treatment and many will still work and continue education etc.

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The Main Differences between Regular and Brittle Asthma

The factors that set Brittle Asthma apart from its Regular counterpart are:

1. The severity of the symptoms.
2. The reluctance of those symptoms to respond to treatment.
3. The sudden and often unpredictable onset of acute attacks.
4. The severity of such attacks.
5. The general overall effect on the life of the sufferer.

Unlike a Regular Asthmatic sufferer, a Brittle Asthmatic sufferer will have their own GP, Chest Consultants, and Respiratory Nurse over the course of many appointments and because of this, they will normally be the first to hear of any new advancements in asthma medicine and treatments.

Living with brittle asthma, whether you suffer with it or care for somebody that does, can be very challenging and at times, very frustrating and it was with this in mind that The Friends' Network was created by Lesley King.

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Treatments for Brittle Asthma

The Main Treatments for Brittle Asthma are:

• Short-Acting medication
• Long-Acting Medication

Short-Acting Medications:

All asthmatics regardless of the severity of their conditions should have access to:

• Fast acting Bronchodilator medicines such as Salbutamol (Ventolin) or Terbutaline (Bricanyl). These open up the Airways and are usually found as metered dose Inhalers to be used as required.

Brittle Asthmatics may find they require larger doses of these Bronchodilators so many have their own nebuliser or have access to the use of one. A nebuliser is a machine that converts the liquid medicine into an easy inhaled mist by passing oxygen or air through tubing up to a face mask or mouth- piece via a medication chamber. This normally work from mains electricity or from a pre-charged battery pack. There are however. Ultrasonic nebulisers which use vibration instead of compressed air or oxygen to create the mist. The bronchodilators used in nebulisers are exactly the same as those found in the inhalers, but in much larger doses.

Some brittle asthma sufferers may also find that they require even more Bronchodilator therapy in the form of sub-cutaneous (under the skin) injections or infusion using a Syringe Driver and again all these Bronchodilators are the same.

Long-Acting Medications:

Regular, long-acting treatment remains much the same as that used by many asthmatics. Steroids may be taken directly into the lungs via an inhaler:

• Common inhaled steroids are Beclomethasone (Becotide, Becloforte and Qvar).
• Budesonide (Pulmicort). Fluticasone (Flixotide).

Another alternative may be a slow release Bronchodilator such as:

• Salmeterol (Serevent) an Inhaled Bronchodilator.

The following are all taken as either short-acting or controlled-release tablets/capsules.

• Theophylline (Uniphyllin, Slo-Phyllin).
• Aminophylline (Phyllocontin)

Oral Corticosteroids such as Prednisolone and Hydrocortisone can also be prescribed when they are required over and above the inhaled ones.

Other Treatments:

As time goes on, many new drugs are being tested and one of the latest daily treatments for asthma is a tablet called Montelukast Sodium (Singulair) and this has been on prescription for a while now and this has helped some asthmatics manage their condition more adequately.

In addition to prescribed medication many severe and brittle asthmatics help control their symptoms using treatments such as:

• Regular Physiotherapy.
• Special Diets designed to cut out potential allergens.
• Breathing techniques.
• Home oxygen Therapy where a person's oxygen level in the blood
  is affected.

Most Brittle asthmatics will most probably have tried most treatments at some time or another and it is up to them and their medical team to find the best combination of medication and treatment for them.

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The Treatment of Brittle Asthma in Hospital

One of the problems with brittle asthma sufferers is that they will usually end up being admitted into hospital, some now and then, but some on a more regular basis. This can be brought about by a sudden acute attack or a gradual deterioration of their condition and either of these symptoms will decide their treatment.

• An acute asthma attack can be very serious and sometimes life-threatening too and that is why hospital is necessary. A patient may need to be resuscitated also before any treatment can begin, but once they are breathing, then the standard protocol can be followed for severe asthma.
• If a patient hasn't already taken a high dose of oral steroids as directed by their own doctor, then this is normally the first step.
• Some doctors may well give he patient intravenous hydrocortisone through a cannula instead or as well.
• The patient's oxygen levels and blood gases will be checked and oxygen given if required.
• Intravenous aminophylline or salbutamol may also be given.
• If the patients condition continues to deteriorate, they may need to be helped with their breathing with the use of a ventilator for a while in an Intensive care Unit.
• A Brittle Asthmatic will only be discharged when they and their
  consultant feel they can cope safely at home.

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Summary:

Many brittle asthma sufferers will adapt well to living with their condition
and some will find a way to do just about any thing. One of the members
of The Friends' Network has now successfully completed two sponsored
abseils to raise funds for asthma research.