What is Brittle Asthma?

A. Pasbjerg

Brittle asthma is a rare, severe form of asthma. Sufferers experience the same symptoms that affect all asthmatics, including wheezing, coughing, and difficulty breathing, but the symptoms are much harsher, tend to come on suddenly and unpredictably, and are often resistant to traditional medications. There are two varieties of brittle asthma, Type 1 and Type 2.

An asthma inhaler.
An asthma inhaler.

Type 1 brittle asthma is characterized by chronic symptoms that affect sufferers on a daily basis. Patients are typically on high doses of daily medication to control their asthma, as regular doses are ineffective. The ongoing nature of their problem often limits their ability to perform normal day-to-day tasks, making it very difficult and frustrating to cope with. In addition to their chronic condition, they usually suffer from periodic severe attacks that come on with almost no warning. These patients often require hospitalization to bring their breathing problems under control, either from an acute attack or because their overall condition degrades significantly over a period of time.

An illustration of the pathology of asthma.
An illustration of the pathology of asthma.

For those with Type 2 brittle asthma, their symptoms are fairly well controlled most of the time. What sets them apart from regular asthma patients are unexpected, abrupt attacks with extremely intense symptoms, similar to those that affect Type 1 sufferers. Often these occasions are severe enough to be life-threatening and generally require hospitalization.

Brittle asthma sufferers may have attacks that require hospitalization.
Brittle asthma sufferers may have attacks that require hospitalization.

Treatment for this condition normally involves the same medications used for regular asthma, but often much more of it is required than in normal cases. Fast-acting bronchodilators are used for quick relief, and steroids, corticosteroids, and slow-release bronchodilators are used for long-term management. Brittle asthma patients may use special methods of delivery, such as nebulizers or subcutaneous injections, to accommodate the larger doses of their medications. Type 2 patients may also use strategies to try to limit their severe attacks, such as avoiding allergens and other triggers.

People with brittle asthma should keep emergency inhalers on them.
People with brittle asthma should keep emergency inhalers on them.

Once an attack has progressed to the point that hospitalization is necessary, patients need to be treated quickly and aggressively, as the condition is potentially fatal. Steroids and other medications will often have to be administered intravenously to help control symptoms. Patients who do not respond significantly to medication may require a ventilator to get extra oxygen. Blood gases and oxygen should be monitored until they come back to normal. The patient's overall status needs to be evaluated to determine if he or she can safely be discharged and manage his or her asthma at home.

It is not uncommon for asthma sufferers to also fall victim to certain allergies.
It is not uncommon for asthma sufferers to also fall victim to certain allergies.

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Discussion Comments


I am 23 years old and I suffer from Brittle Asthma, despite only having mild asthma symptoms growing up. When I hit 17 my whole life changed. Nearly every week I was in hospital with the majority being treated in Intensive Care. I have been intubated a handful of times, gone into cardiac and respiratory arrest twice and had a chronic seizure after staff gave me the only drug that would potentially save my life.

At the very beginning, none of the doctors could diagnose me and I was literally passed from pillar to post, from consultant to consultant and my poor mother was beside herself with anger towards the NHS. I was being let down and some doctors were even too afraid to consult me because I was such a hard patient to manage. But one day a doctor from London took me under her wing and put me on the Xolair trial. It's changed my life completely. Only 8 months in and I have gone from being in ITU every week to every two months which, is a huge improvement and I rarely have any night or day symptoms anymore.

I managed to get a first class honours degree at University and am now currently studying to becomes a barrister. I will never let the condition define me or control my life. I just wish I had more people I can talk to about it when things get tough. It's a lonely condition when it's so rare. If anyone ever wishes to discuss it with me I would be most open to it! Things are easier when you share your experiences, and life seems a little less scary.


Have just lost a friend to this who was 25 years old. Please make sure you get this condition diagnosed. She had it all her life and thought she was controlling it until one severe attack.


My daughter who is 16 has had six hospital admissions in two months. Four of those have been in the last four weeks, and the last one ended up with her being put in intensive care. She has finally been diagnosed with brittle asthma after constantly being told she doesn't have asthma because she doesn't wheeze.

How ignorant! Not everyone with asthma has a wheeze. She has an awful cough when she has an attack. More needs to be done to educate health professionals in recognizing asthma symptoms.


@bear78-- That's a great question.

What sets apart serious asthma and brittle asthma as far as I know is that serious asthma is usually just asthma that's poorly controlled whereas, brittle asthma is asthma that doesn't respond to treatment.

Many people with serious asthma do respond to medication. The issue is that they either don't use medications or they don't use it as prescribed. There are also people who don't have access to health care and can't treat their asthma for this reason.

Brittle asthma is severe asthma that remains so despite using all of the necessary treatments. This type of asthma just doesn't respond to medications. It keeps getting worse and it can occur suddenly like the article said.


I'm a little confused about how asthma is categorized. I've read articles about "severe asthma" and I'm sure that they're not referring to "brittle asthma." What sets these types of asthma apart exactly? How does someone know which one they have?


My neighbor's son suffers from brittle attack. I'm not sure which type but I think he may be type 2 because his attacks come on suddenly and are very severe. The poor thing has been hospitalized twice in the past few months due to severe asthma attacks. Thankfully, he does respond to treatment at the hospital. He's too young to be going through all this though. I pray that he overcomes this condition soon. All asthma sufferers face their share of challenges, but brittle asthma is just debilitating.

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