What is Brittle Asthma?

Asthma is a condition affecting children and adults, characterized by the inflammation of the airways of the lower respiratory system, specifically the bronchus. This inflammation causes an important reduction of the bronchi lumen. Asthma is a non-communicable disease that can be controlled with medication and psychobiological habits to prevent the recurrence of asthma attacks and damage to the lung tissue.

Brittle Asthma

Brittle asthma or severe asthma is characterized by a decrease in the capacity to exhale the air contained in the lungs that is a variation of peak expiratory flow (PEF), this variation leads to severe shortness of breath despite regular treatment to prevent this episode.

Types of Brittle Asthma

Type 1 is associated with immunology reaction in our body by the chemical substances, some organic food, and preservatives in edibles (food intolerance) or by any allergen or substance which activates this reaction is determined by a skin prick test. Several studies have also linked brittle asthma with personality disorders.

Type 2 is characterized by acute and severe attacks of asthma, which is associated with a high risk of morbidity. This type of brittle asthma requires immediate medical attention.

Causes and Risk Factors

Asthma is associated with many risk factors, including genetics (having either or both parents with asthma diagnosis), hypersensitivity to the environment (atopy), earlier and recurrent respiratory infection during childhood that could modify our bronchial epithelium and extrinsic factor-like to substances (chlorine, perfume, detergent), allergen (pollen) or microorganism (acarus) that could cause an asthma attack. Some drugs such as aspirin, NSAIDs, and beta-blockers can also cause asthma attacks.


Inflammation of the bronchi leads to decreased airflow due to the narrowing of the bronchial lumen, this is called bronchoconstriction. This is mediated by various agents in our body such as histamine, leukotrienes, and interleukins that are triggered by environmental factors, atopics, food intolerance, substances, and external allergens, that can cause:

  • Coughing
  • Shortness of breath 
  • Wheezing (a whistling sound is heard when breathing)
  • Chest tightness.

Laboured breathing shows the use of the intercostal muscles.

In severe cases, purple colouration in the face and extremities is due to the decrease in circulating oxygen in the body.

Diagnosis and Treatments

The diagnosis of asthma is made by studying the history of family asthma and the signs and symptoms presented, which is often wheezing due to the narrowing of the bronchi. In addition to this, different studies of lung capacities must be carried out, called spirometry.

According to the Global Initiative for Asthma (GINA), asthma treatment consists of training the patient on their condition and management, control of external factors, and adherence to treatment with long-acting or short-acting inhaled corticosteroids. Asthma control treatment needs to be evaluated every 3 months.

In the case of brittle asthma, treatment can be complex due to its severity. The initial treatment for type 1 brittle asthma, according to the article brittle asthma in the European Review for Medical and Pharmacological Sciences, begins with the reduction of external factors that could cause allergies, avoiding foods for patients who present intolerance and treatment with inhaled corticosteroids. For cases of brittle asthma type 2, the same recommendations are followed in trying to identify the factors that activate asthma attacks, some patients carry syringes of pre-loaded adrenaline for these acute episodes. 

It is important to point out that brittle asthma patients should go to a medical centre for stabilization and even admission.

Tips for preventing an asthma attack

To avoid the recurrence of severe asthma attacks, it is important to adhere to the control treatment, seek medical evaluation every 3 months and take into account the triggering factors, external allergens, food intolerance, strong odours, cigarette smoke, etc.


In conclusion, brittle asthma is a severe form in which asthma attacks can occur, due to the bronchoconstriction that this generates, it has high morbidity and mortality. This type of asthma attack must be treated in a medical centre for stabilization and be under close control. Identifying and controlling external factors that can trigger these attacks is essential without forgetting that adherence to treatment and quarterly control is important to reduce the recurrence of these severe asthma attacks.

This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hugo Uriepero

Medical Doctor - Medicine, Universidad Nacional Experimental de los Llanos Centrales 'Rómulo Gallegos', Venezuela
Experienced as a Medical assistant to tourists through telemedicine platforms with international reach, Rural Doctor and Resident emergency physician.

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