Out-of-hours doctor has just said that my son's asthma is ""a little brittle"" - help!

Have just gotten back from the out-of-hours GP (my son's usual timing for a trip!). His asthma's gone everso slightly out of control since the hayfever season has kicked in. I've been back to the GP and the resp nurse in the last couple of weeks and he's started in flixonase nasal spray. This has helped the runny nose and any associated coughing but he's still been getting breakthrough symptoms - nothing dead serious - some chest tightening, coughing, a little bit of tummy rising, what I call 'accommodating' (changes to his laugh and his voice) and then the associated tiredness/fatigue (not wanting to ride his bike, saying that he's tired etc). He's only three (nearly four) and so his early symptoms are always a bit vague. We've been giving him his salbutamol PRN and this seemed to be doing the trick. Anyway, the nurse and I had planned that if the flixonase nasal spray didn't really make a huge difference then we were to increase his flixotide dose - which we were going to do this morning.

Anyway, last night my hubby gave him his salbutamol after going to sleep as he thought his breathing was a bit noisy (I was out at a party). His breathing was still a bit noisy when I got in, but we weren't particularly worried. But this morning when he woke his breathing was really raspy and he was coughing a lot. So we rang the docs as it seemed like he might be heading for an asthma attack. The out-of-hours GP was really thorough. He did a really good history, went through our son's notes on screen and did a really good chest exam. He was very thorough and said we'd done exactly the right thing to bring him in - which always makes me feel better! He said that he definitely had a wheeze going on inside (even though you can't hear it on the outside) and has suggested increasing his flix (which we were going to do) and to keep a dead close eye for any deterioration and to give him regular salbutamol. As we were going out the door he just kinda said to me that Ralf's asthma has gone a ""little brittle"". He said again when I was thanking him for taking time to see Ralf. But as soon as I got out of there I started to get a rising panic by the word ""brittle"". No one has ever said to us that they think he's brittle and I'm just wondering what he's based this on? Can you really hear a difference between brittle and non-brittle in the chest examination??? Which is all he has to go on really, as my boy's too young to do his peak flow and other resp measurements. I don't know what to think now and am just wondering if he's used the term loosely? What do you think? Any advice would be welcomed as I'm feeling a bit frazzled again. Thanks x

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  • terminology...

    Hi

    I think brittle just means out of control. I was told i never had asthma a good few years ago and that it maybe allergic asthma (there is no diffrence). In 08 it was dubbed as asthma and then in 09 Chronic. I think the variations occur when there is a change in symptoms.

    the name issue is in another topic: asthma.org.uk/applications/...

    The trick to controlling your sons asthma maybe similar to what i am currently doing - I have 3 inhalers of which two are preventers at different dosages. I have a preventer during the day and the stronger one during the night (as my symptoms are worse during the night) this keeps me from getting too bad and on steriods.

    Has your son been given singulair by chance?

  • Hi I was told brittle asthma is difficult to control asthma. I have been told my asthma is brittle at the moment (was mild) but my Son who is 10 has brittle asthma type 2 which has been the case since he was 6months old. He has months of well controlled asthma, then suddenly without warning it gets worse very quickly. He has to be treated very quickly with vast amounts of ventolin (inhaled and nebulised) to stop him getting worse.He is also on lots of preventative treatment to stop attacks.He has high peakflows and no wheeze but often has life threatening attacks.It has taken 9 years to diagnose his asthma properly. He has damage to his spine and ribcage where he has had trouble breathing. It's a very rare form of asthma so try not to worry.My other Son has mild asthma but it becomes brittle with allergies and easily controlled with the correct treatment unlike my youngest Son and me.I'm still trying to get the correct treatment so it's still early days for me, mine may become mild again.

    Hopefully in your Son's case, it's just a blip and with the correct treatment will be well controlled again.

    Take care

    Kate x

  • why didnt they give you a nebuliser to keep over the bank holiday weekend.

    Hi

    they should have given you a nebuliser to take home. Unless you already have that. Thats what the paramedic asked me last time I had a nasty attack and was explaining the whole history prior to the series of attacks - but then i requested a second preventer and it seems to do the trick.

  • well, his asthma's not that bad and he is responding well to his salbutamol, so i don't think he needs a neb. i was just a bit taken back by the doctor using the term brittle. I don't know much about it but thought that there were diagnostic criteria and all he did was take a history and do a chest exam. think i'll just take him back to our regular gp next week and see what they think. if they do think he's brittle then i would ideally want him to be under the care of a specialist,as he's still young and it's difficult to know what's really going on.

    he's sat bolt upright tonight as it's just cough, cough, cough if we don't. he's a right little wriggler in his sleep so tonight's going to be fun trying to keep him there! wish me luck....!

    thanks peeps x

  • Just to reassure you, I honestly believe too many non specialists use the term 'brittle asthma' far too loosly.

    Brittle Asthma is a specific phenotype of asthma with the following definition:

    Since 1977, the term brittle asthma has been used in different ways by different physicians, leading to some confusion over whether such a group is truly separable from other patients at the severe end of the asthma spectrum. In order to try and clarify this area we have suggested a classification of brittle asthma into two types; a feature of both types being a susceptibility to repeated severe attacks resulting in hospital admission.

    Type 1

    Patients who consistently demonstrate wide peak flow variation (greater than 40% diurnal variation for at least 50% of days), despite maximal medical therapy including at least 1500 µg/day of inhaled beclomethasone or equivalent, are classified as having type 1 brittle asthma.

    Type 2

    Patients with type 2 brittle asthma appear to be well controlled between attacks which are often sudden in onset (occurring within minutes) and are associated with loss of or disturbed consciousness on at least one occasion.

    As you can see brittle asthma is just one form of severe asthma. Unfortunately many GP's and even generalised paediatric consultants use the term to describe asthma that is not particularly well controlled. It can be normal (albeit frustrating) to go through a period where asthma control is lost especially during heyfever season or after a nasty infection,however with the correct treatment a great majority of people will regain control. This quite often takes time to find the right mix of medication/doses that work for you. There are 5 steps of asthma treatment to work your way through before being classed as 'difficult to control', and only 5% of people with asthma ever get to this stage.

    My son was described as 'brittle' by his local consultant and after 5 years of not being controlled on 'maximum' meds and regular admissions he was referred to a specialist centre. He has had numerous 'labels' for his asthma since being there including, difficult, steroid resistant/dependant/sensitive, severe therapy resistant and just plain old severe! He has tried all conventional meds and a number of specialist treatments, none of which have made much difference, but he has never been labelled Brittle.

    What I am trying to say is don't worry, you are correct in thinking the term was used loosely and as your little man grows hopefully his asthma will improve but if not it is more than likely to be well controlled.

  • Koolkat - thank you so much. Your descriptions are pretty much what I had in my head as being brittle and my son's absolutely nowhere near that. He does lose control, but like you say when he has a definite trigger about. He's doing much better now, we've upped his steroid for a bit and it's just starting to make a difference, and he's just coughing in the morning now. And we have a holiday in Anglesey to head off for tomorrow - yippppeeee!

    Thanks again for everyone's feedback - it really helps a neurotic Mummy that always has too many questions! Even though I am much more confident in judging if my boy's heading for symptoms and I have a brilliant GP service and resp nurse, I still find asthma really scary, but I suppose I always will. x

  • If it's any consolation I have just picked up one of these new 'fit notes' from my GP stating I'm currently 'brittle/unstable' but OK to look for/start work again. (That'll impress a prospective employer.)

    It spooked my when I first heard it, but from the conversations I've had I get the impression it means I'm unstable at moment but docs and asthma nurse hope and think my asthma will become controlled.

    Must be really scary with a little one though! Hope he's better soon.

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