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Brittle asthma description - feel quite insulted! - *edit I take it back!!

Hi All,

during todays enforced rest after yesterdays admission I've been doing quite a lot of reading and came across a brittle asthma management plan by Professor John Ayres at Heartlands. It makes very interesting reading but he talks a lot in there about the psychosocial manifestations in brittle patients and psychlogical instability!

In some areas of the article he appears to be suggesting that the hysterical panicked response is responsible for the attack.


This is the link to the article:


What does anyone else think?


*edit - spelling mistakes - again! Sorry

*edit number 2 - I take it back - just found the full article online and I think it reads differently.....I'm not insulted now lol!!

This is the link medind.nic.in/iae/t01/i1/ia...

11 Replies

Hi feejay,

although I've had asthma for over 10 years it's the first time I've come across brittle asthma types. I read your posted article with interest but please don't forget that there's many different opinioned studies out there!

My question is: what's the difference between ""just asthma"" and the brittle types? I understand that type1 has the very varying pf readings but a little confused about type2 about the sudden onset if an attack.

I only get slower insets when I come down with a chest infection but the hayfever or recently strong emotions can trigger it out of nowhere. Been semi conscious a few times with it so is that normal asthma or could it be brittle type2?

As to your question I think emotions are generally a big deal in asthma. Emotions can trigger asthma but asthma can also trigger panick etc.

If that makes sense?

Glad you mentioned this topic and hope you're feeling better.

Take care

love Lydia x


Hi Lydia,

Yes my title is slightly tongue in cheek given that emotion plays a part in asthma, I just felt he was saying all brittle asthmatics are brittle because the have psychosocial disorders! To an extent anyway.

There is quite a bit of info on the various types of asthma on this site and some very knowledgeable people on the boards.

To some extent it doesn't make a huge amount of difference what ""type"" you are, more about control and treatments I think.

I'm sure wiser heads than I can comment on this!



Hi feejay,

I can absolutely imagine how that article disturbed you.

Just thought I'd let you know about those different studies. I did a research for uni once and was quite astonished how many different results if those you can find ;-)

and yes you're right about the asthma types. There's so many varieties in symptoms etc. What anoys me is when I'm bad and get to a&e the docs first say: ""it's not too bad you're not wheezing"".

But that's a different matter.

People should do some more training/research in different types.

My asthma nurse is brill as not small minded;-)

love Lydia x


I think that part of the problem is that asthma is almost a a generic term . It covers a number of respiratory problems, different symptoms and differing treatments.The degree of severity ranges from mild to severe, treatable to struggling. Unfortunately many of the the medical profession are stuck with one description. shortness of breathess and a wheeze. There are many out there who recognise asthma as a problem and help with good advice and treatment. Hopefully we can get all the medical profession that treat us consultants, GP, nurses, paramedics etc that asthma is 'real' .



brittle asthma in adults comes in two types: type 1, showing more than 40% diurnal variability in PEF rate on most days over long periods and type 2, with acute severe attacks (often sudden) on a background of apparently good asthma control.

Adults with brittle asthma are generally atopic, An allergic reaction that becomes apparent in a sensitized person only minutes after contact.

but I agree with John, asthma is a generic term to give doctors an easy route to diagnosing something they really can't explain in a vast number of cases. Asthma is more than one condition, I've said that many times and much more research is need, but were getting there.


Having just read that article you linked to Fee, it does strike me basically sound, the two types of brittle are clearly distinguished and also acknowledges that upon arrival at A&E you can appear to be perfectly normal despite only 5-10 mins earlier in great distress, so full marks there. Basically it summarises all that I've read apart from never seeing anything to suggest the abuse and relationship issues it quotes before, but the vitamin link is well documented, whether the lack of vitamins causes the problem, or it's some function of the body that prevents absorption is still open to question.

The charts were interesting, never seen those before. Fig1 looked like mine if you flip it horizontally.


Hi Fee

I worried about some of the stuff I read about Brittle asthmatics especially the unstable bit,charming!!

I used some of this information from link when letting the school know how they failed to look after my Son a few months back. Emotional issues do trigger my Sons attacks, he has type 2. They are not hysterical outbursts, just having an argument with his friend in class at school started the last severe chain reaction. Excitement at Christmas and Birthdays do it too. He had a row with his brother last week and My eldest ended up giving my youngest his inhaler while still arguing with him.I carry the inhaler when I tell him off.

The hysterical panicked response seems strange. My Son has severe attacks whilst still sleeping, unless it psychological (not that word again!!)

Hope you feel loads better soon, and get some help (someone with the right ideas and medication)

Take care

Kate x


On a side note where you mentioned about the psychological issues. My understanding is that often people with brittle asthma suffer psycholigcal issues as a result of it. I have discussed this once with my asthma nurse. She said that because of the difficulty in treating brittle asthma patients often develop psycholgical issues due to frustration etc as it can be very isolating and difficult to deal with and not everyone with brittle asthma has the same disease process and different things effect people differently.

I know stress has always set my asthma off and my way of coping is often to jsut blank eveyrthing out. This had become a viscious cycle but and I think i speak for alot of people with brittle asthma that help from medivcal professionals can really help if you are willing. there is often stigma about seeing a psychologist or something but i see someone who helps plan what i can do on bad days and have coping strategies etc for when i am gettign frustrated with my asthma as it prevents me from doing what I want. She also comes and sits in on my appoitments with my consultants so she has a full understanding of it and then we can plan what i can and cant do and what i wnat to do but it may cause problems and how to get around those.

I overall rate prof ayres pretty highly in the asthma consultant world. he is highly qualified and what he states in that article makes sense and i can relate quite strongly to what it says.



Editing number 2

Just edited the original post as I found the full artice online....link pasted above.

Edit - Olive - no offence intended towards Prof Ayres.....just wanted to know what others thought of his findings


Mmm, from your reply (I know the complete article well, been around for a bit) I though you were just picking out one bit. Glad you have found the complete article.

Has some good info on Brittle asthma and how It all came about.

Take care




It's an interesting topic the link between stress/emotion and asthma. I don't know anything about brittle fortunately mine has always been mild to moderate. But for all asthma I know that for me stress and emotion may make me more susceptible especially to seasonal allergies and eczema. However I always like to emphasize that there are clear direct physical effects. If you give me a handful of well sulfured apricots I will wheeze audibly within 5 minutes. Doesn't matter if I'm on vacation and all is wonderful or in terrible stress. In California the wind blows and we have these "pollen days" - when 5 other people around you are sneezing red eye and sinus terribly and you have some asthma on that day - they can't all be under the same stress as you statistically. In my belief there are both physical and stress components but how they interact or feedback is very hard to know.


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