Brittle Asthma

[Homely2]

My gp asthma nurse today said that I had brittle asthma. I did not think much of it, until I went away to look it up. It did not make nice reading.

Has anybody any experience of this.

[eleanordigby]

I have severe asthma and am on biologics, but brittle is a different category. It’s just a label though. You’re no different from what you were yesterday, before you saw the nurse (though in your shoes I’d want that diagnosis confirmed by a dr). In fact, you’ve now got an explanation for your asthma symptoms so maybe you can learn how to manage them better? I’ve also got other conditions and on paper I appear quite ill. I just take each day as it comes. Some are much better than others 😊 I try not to worry too much about the future x

[Lysistrata Administrator Community Ambassador in reply to eleanordigby]

Brittle is really just an older term for severe, unstable asthma, and is often used for anyone with that. I don't think it's an official term anymore, but of course is still used at times, especially by healthcare professionals and others who are used to it. asthmaandlung.org.uk/condit...

Googling shows that the term is still floating around the internet, even on more modern sites - I've just found a truly terrible article on WebMD from last year(!) which is mixing up all sorts of triggers, mechanisms, treatments etc by dividing them into brittle asthma type 1 and 2, and really isn't in line with modern research.

I can see in general why the term is not really used anymore, as the descriptions seem to be based on older understanding of asthma. I remember brittle asthma types being a frequent topic of discussion on the earlier version of this forum in about 2011. It's not necessarily always wrong as a description of how asthma can present, it's just a way of categorising things that doesn't account for more recent ways of understanding why asthma is unstable (and the two types aren't necessarily either/or). The way we categorise asthma now may well be seen as old-fashioned in 10-15 years! (I almost hope so really, given my consultant's very narrow views).

A friend has commented that her specialists no longer use it, even though she would have been considered brittle under the old definitions. However, GPs/paramedics may use it for more unstable asthmatics - and she said she finds non-specialists tend to see brittle as much more scary, whereas specialists just see it all as severe asthma. One paramedic thought she was ok to go to hospital in the car once 'because you're severe not brittle'. He was very alarmed when she cheerfully said oh no, I'm brittle, we just don't use the word that way anymore.

Homely2, I agree this shouldn't change anything - and it doesn't mean you will be this way forever! It may be that it's describing you now, but it may not be once you find the right medication for you.

[Pipsqueak77 in reply to Lysistrata]

Hi

Agree with the comments above…. My understanding is that it is just the older term used to mean a severe asthmatic.

I have to say it’s not used by anyone at my tertiary clinic … they just refer to severe phenotypes of asthma, which incidentally are usually diagnosed only by them.

Hope this allays your fears a little!

Take care

😊

[Homely2 Administrator]

Thank you everybody, I found the Webmd article mentioned by lysistrata, and I must admit it did unsettle me.

[Lysistrata Administrator Community Ambassador in reply to Homely2]

That article is really awful! When I checked who medically reviewed it, it turned out to be an ER (emergency) doctor. Despite what some specialists think, A&E doctors do generally know how to treat acute asthma, but they're not always necessarily up on the finer points of the research, and this particular doctor really doesn't seem to understand it at all.

Which is often fine by me as specialists can get hung up on putting people in boxes at times (in my experience, and especially with my current team). But it's not fine when it comes to providing information.

That article should have been reviewed and extensively rewritten by a specialist in the area - or better still, retired and replaced! It's just so old-fashioned and, as you've found, unhelpful. It has very little relationship to reality or science, whereas some descriptions of brittle asthma just stick to the types of attacks people have which isn't necessarily wrong. I don't even think this article would be correct 20 years ago if you just observed severe asthmatics and their triggers.

Please excuse the rant lol, this is my kind of area workwise (the communications part, I'm not a doctor), and I always get annoyed when I see it done badly.

[Cat33]

Yes our son was diagnosed with brittle asthma as a child He was so so poorly and we were so fearful of his future

He's now a serving police officer in firearms and fighting fit

Wishing you all the very best

[MikeWhite]

The Royal Brompton Hosp in London who I’m going under call mine Difficult & Persistent Asthma, I’m on a biological - Xolair plus other meds ti control the asthma plus lots of others to control other conditions caused by longterm high dose prednisolone use but all good, I just keep popping the medications and life is not too bad, in fact pretty good.

My biggest change was when Covid hit and I had to shield & work from home, no more chest infections picked up from coworkers ( 4000 on company campus) and it’s chest infections that used to put me in resus 4 or five times a year.

Don’t left a label affect you, if you are feeling well brilliant, don’t dwell on what might happen & if you are poorly take time to recover as rushing back to work & normal life too soon just elongates your poor health.

Wishing you the very best

Mike

[Itswonderful in reply to MikeWhite]

excellent Mike! I think you put it very well.

[JAmanda in reply to MikeWhite]

super helpful, thsnks. Told I had brittle asthma today and referred to royal Brompton for biologics and hopefully better care. Thx

[hoven]

a paramedic used the term and I did n 't like the sound of it at all!

[Africanleopard Verified User]

Hi Homely2

As a doctor and someone with asthma I agree with the comments of others that ‘brittle asthma’ is an old term that is not used any more by those of us with asthma expertise.

We define severe asthma as: asthma that remains uncontrolled despite high doses of asthma medication that you are taking as directed by your doctor and that your inhaler technique is correct. And that becomes uncontrolled again if you stop your preventer / controller inhaler.

Difficult to treat asthma is defined as: Asthma that is treated with high dose asthma medication- without information on if you are taking the medication or if you’re using your inhaler correctly - most people with difficult to treat asthma are controlled if their medication is optimised and once it is taken correctly as prescribed.

So if your asthma is uncontrolled and your doctor thinks your asthma needs a specialist opinion my suggestion would be to ask your doctor to arrange an emergency appointment with a respiratory doctor at your local hospital in addition to waiting for your July appointment- because there is a risk of having an attack if your asthma is uncontrolled.

[SilverWillow]

I agree with all the other replies - don’t worry about the label of “Brittle”. One of nurses at my doctors’ surgery purposely made a note on my medical notes that I had Brittle asthma only last month. When I queried what it meant, she said that if I rang for an urgent appointment about my asthma, the receptionists would know that I had to be given an appointment that day as I needed attention.

I am grateful for that because I had an asthma episode in February (peak flow down to 200 and chest infection) the receptionist told me there were no appointments with anyone that day (8.30am) and the next appointment with the asthma nurse was a week away. Long story - won’t bore you all here. So if by being labelled as having Brittle Asthma means that the receptionists actually take note and find me an appointment then I am very relieved. Hope the same works for you.

[Bea2000]

I also got told a few months ago by a GP I have brittle asthma - I've had diagnosed asthma for the last 15 years (when I was 8) and no on me has ever said this before. He was so casual 'oh for brittle asthma like yours, we recommend' I genuinely stopped listening because I didn't know my asthma had been catagorised at all, let alone as brittle