Brittle Asthma Life Expectancy

Overview

Asthma is a heterogeneous disease that affects the airways in the lungs. Airways carry air in and out of the lungs through a tube. If you have asthma it means that at times, the tubes in the airway become smaller and inflamed. Asthma makes the body's immune system attack harmless matters like dust mites, mould spores, animal dander, and some foods. It is believed that asthma affects up to 300 million people worldwide, according to NICE.¹¹ It often starts during childhood. However, it can also affect people during older age. There is no cure for asthma but there are ways you can manage it.  Brittle asthma is a rare form of asthma characterized by a wide variation of Peak Expiratory Flow (PEF)¹, despite high doses of inhaled steroids and bronchodilator therapy. Brittle asthma can cause very serious and often life-threatening allergic reactions.

Causes and Risk factors

Your likelihood of developing asthma may arise due to a variety of factors such as:

• Having an allergy-related condition, like eczema, hay fever, or a food allergy. These are called atopic conditions.¹ 
• Asthma or allergies running in the family.¹
• Being born early (before 37 weeks) or with a low birth weight; bronchiolitis – a common childhood lung illness; having been exposed to tobacco smoke as a kid; and your mother smoking during pregnancy.¹ 
• Some people may also be at risk of getting asthma because of their job.¹

The precise cause of asthma is unclear. In those who suffer from asthma, the airways become enlarged (inflamed) and "sensitive", making them more likely to get constricted and clogged with mucus when they are exposed to particular triggers.¹ 

Asthma has been linked to genetics, pollution, and contemporary hygiene standards, but there isn't enough data to establish if any of these factors are to blame.¹

Types of brittle asthma

Type 1

This type of brittle asthma makes it hard to breathe all day, even if you take asthma medication. It changes your peak flow, which is how much air you can force out of your lungs in one strong breath. Most of the time, people with this type of brittle asthma have peak flows that are widely inconsistent despite treatment, and well outside of the normal range.²

Type 2

People with type 2 brittle asthma can sometimes control their asthma for a lengthy period using standard treatments. However, this type of brittle asthma can be unpredictable and some patients may suffer from severe asthma episodes. Severe episodes may require the use of a mechanical ventilator, which aids breathing. Type 2 brittle asthma attacks can sometimes be life-threatening.² 

Symptoms

Symptoms of brittle asthma include³:

• Tightness in the chest
• Coughing (often late at night or first thing in the morning) 
• Breathlessness 
• Wheezing, which sounds like whistling when you exhale 

Symptoms can be caused by other conditions. Symptoms of asthma tend to follow a pattern³: 

• They come and go over time or even within the same day. 
• They start with or get worse from viral infections, like the common cold. 
• They are brought on by weeping or laughing too much, exercise, allergies, chilly air, or quick breathing. 
• They are more severe at night and in the morning.

Diagnosis 

Brittle asthma patients frequently need to go to the emergency department or visit their doctor regularly. The severity and frequency of the person's asthma symptoms, as well as the person's medical background and the results of a physical checkup, will help the doctor make a diagnosis. Tests are used by doctors to assess the severity of asthma.⁴ 

The following are the most common tests used to help diagnose asthma(5): 

FeNO test. The test determines the amount of nitric oxide in your breath using a device that requires breathing into it. The test reveals how much inflammation is present in your lungs.

Peak flow test. For this test, you blow into a portable device that monitors how quickly you can exhale, and this may be done multiple times over a few weeks to observe whether it varies over time.

Spirometry. Spirometry evaluates how quickly and how much air you can keep in your lungs by having you blow into a machine. 

After receiving an asthma diagnosis, you could additionally have an X-ray test or an allergy test to see whether your symptoms could be brought on by an allergy.⁵

If your doctor detects a problem other than asthma, you may need⁶: 

• A computerized tomography (CT) scans
• X-rays
• Sinus CT scans
• Blood tests 
• An evaluation of gastroesophageal reflux 
• An examination of the phlegm in your lungs for signs of a bacterial or viral infection

Asthma is frequently accompanied by other disorders that might exacerbate symptoms, so your doctor may also check to determine if you have any of those.

These disorders include⁶:

• Heartburn (GERD)
• Sinusitis
• Hay fever

Additionally, your doctor could conduct an allergy test. These might involve blood testing, skin tests, or even both. Allergy tests can uncover an allergic illness, like hay fever, that may be causing your symptoms or exacerbating an asthma diagnosis even if they cannot be used to diagnose asthma.⁶ 

Finding the root of respiratory issues might be difficult at times. In young children, it can be challenging to distinguish asthma from other diseases. 

It might be more difficult to diagnose asthma when it coexists with another disorder that impairs breathing.⁶ 

Your doctor may provide drugs or other treatments even if a diagnosis isn't clear to see what works. To make the right diagnosis and choose the most appropriate course of action, patience and time may be needed.⁶

Assessment

Assessment of severity

Moderate worsening of asthma⁷:

• PEFR >50 to 75% best or predicted. 
• Oxygen saturation (SpO2) ≥92%. 
• Speech is normal. 
• Approximately 25 breaths per minute. 
• A pulse rate of <110 beats per minute. 

Acute severe asthma means any of the following⁷: 

• PEFR best or predicted 33–50%. 
• Oxygen saturations (SpO2) ≥92%. 
• Can't make whole sentences. 
• A breathing rate of about 25 breaths per minute. 
• A pulse rate: is ≥110 beats per minute.

In a patient with severe asthma, the presence of any one of the following is considered to be life-threatening asthma⁷: 

• PEFR <33 is the best or most likely. 
• Oxygen saturations (SpO2) <92%. 
• Silent chest, cyanosis or poor respiratory effort. 
• Rhythm disorder or low blood pressure. 
• Exhaustion and a change in consciousness.

Treatment

People who suffer from brittle asthma are challenging to treat. Due to the high doses of inhaled steroids and bronchodilators that brittle asthmatic patients need to take, the standard guidelines for asthma cannot be applied to their care. So, if their symptoms get worse, they have to take oral steroids.²  

Non-drug treatments include getting rid of allergens, finding and staying away from foods that cause reactions, and getting good dietary advice.²

1. The treatment starts with limiting the patient's exposure to allergens and keeping them from eating foods they are allergic to.² 
2. Immunomodulators: Cyclosporine, Methotrexate, and intravenous immunoglobulins have been tried to lower the number of steroids needed.² 
3. Long-term continuous subcutaneous infusion of beta 2 agonist - terbutaline 3-12mg/day.²
4. Long-acting beta-2 agonists.²

Type 2 Brittle asthma is easier to deal with than type 1. Patients with type 2 brittle asthma who don't have many symptoms are treated by limiting their exposure to allergens, figuring out what sets off their attacks, self-managing their asthma, and dealing with attacks when they happen. Every patient should be given a card with important information and, if possible, a preloaded adrenalin syringe (EpiPen) because attacks can happen quickly and severely without warning, requiring emergency care. After the patient has been given adrenalin, they should be told to use a dose of nebulized salbutamol or terbutaline and go to the emergency room. Mechanical lung ventilation is necessary in the event of acute respiratory failure.²

Life expectancy

Patients who suffer from severe asthma have a decreased life expectancy and considerable morbidity as a result of inadequate control of their condition as well as the harmful effects of high-dose corticosteroids. Most patients continue to have severe asthma.⁸

When to contact your doctor

If you or your child has asthma symptoms, you should talk to your doctor. If there is anything you know that puts you at risk for asthma, let them know. It's important to get a diagnosis and receive the appropriate therapy. Most of the time, the doctor will be able to tell if someone has asthma by asking about symptoms and doing a few simple tests. Symptoms to look for include, breathlessness, a tight chest, coughing and wheezing.⁹

Prevention

Having an asthma management plan is the greatest method to prevent symptoms for those who have asthma. The asthma management plan is something that you and your doctor create together in order to assist you in taking control of your asthma rather than allowing your asthma to take control of you. An effective plan should allow you to¹⁰: 

• Exercise without experiencing asthma symptoms. 
• Participate fully in sports and exercise. 
• You can sleep through the night, even if you have asthma.
• Go to school or work regularly.
• Have very few or no side effects from asthma medication. 
• Have no hospital stays or emergency visits.

Management of Asthma¹⁰ 

• Be aware of your asthma triggers and try to avoid them. 

The best strategy to reduce your dependence on medications and stop asthma attacks is to avoid your triggers. You must first identify these triggers, though. As you list your triggers, identify the ones you can avoid and the best ways to do so. You might also want to ask your doctor about allergy medications that could lessen allergy symptoms.

• Take your asthma medications as recommended.¹⁰

Most asthma medicines are breathed in through a nebulizer, a metered dose inhaler (also called an inhaler, puffer, or MDI), or a dry powder inhaler (DPI). Inhalers must be used properly in order for them to function effectively. But more than half of people who use inhalers don't use them correctly. Ensure your technique is sound by asking your doctor or nurse. 

• Monitor your asthma and look out for any early warning signs that it could be getting worse.¹⁰

Episodes of asthma rarely happen suddenly. Early symptoms might include coughing, chest discomfort, and/or fatigue for some persons. But bear in mind that because lung airways constrict gradually, you might not experience symptoms until your airways are seriously obstructed. Taking your medication as soon as you notice that your asthma is getting worse is essential for controlling it. 

A simple, pocket-sized tool called a peak flow meter can help you find airway constriction hours or even days before you have symptoms. You just blow into it, as instructed by your doctor, to check your airways. The good news is that utilizing your peak flow meter ought to result in fewer symptoms, doctor visits, and hospital stays!

• Be aware of what to do if your asthma worsens.¹⁰

If you comprehend and adhere to your asthma management plan, you will know exactly what to do in the event of an asthma attack or other emergency. Ask your doctor if you have any queries at all.

Summary

People with brittle asthma have different outcomes. It is crucial that individuals properly manage their symptoms because the disorder has the potential to be fatal. To regulate their symptoms, a person may need to use a variety of drugs and therapies. Those who suffer from brittle asthma can benefit by being aware of the factors that bring on their symptoms and avoiding those factors whenever it is practical to do so while continuing to take their prescription medication. Determining whether therapies are effective can be made easier by working closely with a doctor. Additionally, it's crucial that individuals are aware of the early symptoms of an asthma attack and seek medical attention immediately.