whats the difference

Hi I was just wondering i anyone knew whatthe difference was between chronic brittle asthma and normal asthma. My Asthma physician told me I had the chronic britte type. I didnt think there were several types I thought there was only one type. But because I have been in intensive care 3 times and HDU 4 times inthe last year they are now saying I have this.

While im on how can ou avoid house dust etc if ur allergic to it

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Hi Marina,

Welcome to Asthma UK, I'm sorry to hear that you have been having so many problems with your asthma over the last year.

In answer to your question, there are many types of asthma, and quite a few types of chronic, severe or difficult asthma. I believe the Brompton have been quoted as saying they have identified around 12 different patterns of severe or difficult asthma (perhaps someone could correct me if I've misremembered this figure). Brittle asthma is a phrase used to define two different strictly defined forms of severe asthma. It is a term that is being used increasingly, and not necessarily correctly in all cases. It is only one form of severe asthma and is not necessarily any better or worse than any other form.

Type I brittle asthma is defined as asthma that is unstable for most of the time despite high dose medical treatment - the strict definition is that there must be greater than 40% variability in peak flows throughout the course of the day for greater than 50% of the time despite medical treatment including high dose inhaled steroids.

Type II brittle asthma is asthma that may appear quite well controlled on a day-to-day basis, but that has a tendency to deteriorate rapidly and severely - typically, sufferers can go from being perfectly well to having a severe or life-threatening attack in under three hours.

Some people may have features of Type I or Type II brittle asthma, but not meet the strict diagnostic criteria, and some may have a mixture of the two, for example having the sort of chronic day-to-day instability that is normally associated with Type I but also suffering from the sudden onset attacks more characteristic of Type II.

Brittle asthma should be diagnosed and managed by a hospital respiratory physician, often one with an interest in managing severe or difficult asthma. Often, a number of tests will be done before diagnosis, both to try to determine how severely the person is affected and to try to rule out other causes of the symptoms.

In terms of your other question about avoiding house dust - this can be extremely difficult. In most cases, it is the house dust mite (or actually their droppings) that triggers the allergic response. The mites live in bedding, carpets, cushions and clothes, and feed off dead skin cells, which we all shed. Making changes to eliminate the mites from your household environment can be quite difficult, and there isn't particularly very good evidence that it improves symptoms in adults, as there are lots of other factors involved in the allergic response.

There are a few basic (although not cheap) things that you can do to try to reduce your contact with house dust mites. Taking up carpets and replacing with wooden or laminate floors that can be vacuumed or polished, with rugs that can be washed, can be of help. Replacing curtains for blinds that are regularly damp-dusted can also help. Walls, woodwork and surfaces can also be regularly damp-dusted. Minimising soft furnishings can also help, as well as getting rid of excessive clutter like soft toys, cushions, dried flowers and so on, which collect dust.

Using a vacuum cleaner that is designed for allergy sufferers, with an allergen filter on it, may be more effective than using one without. Dusting should be done with a damp cloth that traps the dust. Ideally, someone other than the allergy sufferer should do the cleaning, or if this is unavoidable, a mask should be worn while cleaning.

Bedding that is designed to be low allergen can be helpful, but it is expensive, and it is probably just as effective simply to use cotton sheeting that can be regularly (weekly) washed at a high temperature (greater than 60 degrees) to kill the mites. Duvets and pillows can be put into bin bags and put in the freezer for 24 hours once a month, which will also kill most of the mites present. Leaving bedding open to air each day rather than making the bed up will reduce the number of mites which are breeding there.

There are a lot of other products which are touted as reducing exposure to allergens such as dust mites, and everyone is different in how useful they find these products. It is worth being wary, though, because a lot of these products are quite expensive and may not produce the improvements that have been promised.

Hope this helps

Em H