Status and brittle asthma

Well-recognised condition

Although asthma is a well-recognised condition, experts don’t always agree about the precise definition describing the condition and its symptoms. They do, however, agree that asthma is a condition that affects the airways; specifically the small tubes that carry air into and out of the lungs. When the airways are constricted (narrow) or become inflamed, people with asthma may experience what is called an asthma attack.

The following symptoms are characteristic of a classic asthma attack:

• • Shortness of breath

• • Wheezing

• • Coughing

• • Chest tightness.

These symptoms usually occur or are worsened by the following:

• • Certain viral respiratory infections such as flu, and allergies such as hay fever

• • Certain medications such as aspirin and ibuprofen in some cases

• • Indoor allergens such as aerosol sprays and perfume, dust mites, cockroach allergens, mould, fungi and animal dander

• • Workplace related allergens such as poor air quality, cigarette smoke, wood dust, soldering flux and a variety of chemicals

• • Outdoor allergens and air pollution

• • Breathing cold, dry air

• • Exercise

• • Stress

• • Food preservatives and dyes, especially dietary sulphites.

Global rates of asthma have increased significantly and although millions of people worldwide suffer from asthma, most have learned to recognise the symptoms and avoid the triggers that cause flair ups and asthma attacks.

Determining severity

Asthma is often categorised as either intermittent or persistent according to how frequently the attacks occur (number of days/nights per week) and how severe the flair-ups are. Flair-ups are symptoms that require treatment with reliever/controller medicine or inhibit daily activities. According to its symptoms, persistent asthma is subdivided into mild, moderate or severe.

Severe asthma attacks

Status asthma

Although all asthma sufferers may sometimes have more severe attacks, an acute severe asthma attack that does not respond well to standard asthma treatment and therapies, is a much more serious form of asthma now recognised and treated as a life-threatening medical emergency.

These acute, therapy-resistant, severe attacks (previously known as “status asthmaticus” or “difficult asthma”) either occur suddenly between midnight and 8 am in older individuals and often in response to exposure to certain allergens, or more gradually and over a period of more than 48 hours.

Brittle asthma

Brittle asthma is a rare type of “difficult asthma” characterised by recurrent, severe attacks. Although it is rare and only occurs in approximately 0.05 to 5% of asthma suffers it presents a serious health risk. Those suffering from this type of asthma have breathing difficulties most of the time and also suffer frequent serious and life-threatening attacks that need emergency hospitalisation.
Two subtypes have been identified:

• • Type 1 is characterised by sustained, chronic attacks despite medical therapy

• • Type 2 is well-controlled asthma characterised by unexpected, sudden, severe attacks.

Brittle asthma is present in both sexes in the age group 18 to 55 years. More women than men have been diagnosed with subtype 1 and this subtype is also more difficult to manage and is responsible for more hospitalisations. Experts suggest a holistic approach with particular attention being paid to psychosocial factors associated with this type of asthma. Type 2 is slightly less difficult to manage but still potentially life threatening if not attended to immediately.

This severe type of asthma is the most common cause of paediatric intensive care unit (ICU) admissions for children and the third most common cause of all hospital admissions.

Treatment

The most important treatment option for an asthma sufferer, especially for status and brittle asthma sufferers, is to work in partnership with your doctor in devising a treatment plan to help you cope when you can and an emergency plan when you can’t. It is important that your doctor or specialist monitors your symptoms and lung function often and also checks for any form of infection in your lungs. Certain standard and additional asthma medications may be prescribed to help control attacks and it is wise to wear an identification bracelet that identifies these and the fact that you are an asthma sufferer.

Avoiding known triggers and staying as fit and healthy as possible by drinking enough water, eating the right food and exercising (even if you suffer from exercise-induced asthma) is up to each individual. Joining a support group and talking to others with similar problems can be a bonus and encouragement during difficult times.

Sources
Asthma. Retrieved from: http://en.wikipedia.org/wiki/asthma
Asthma attack. Retrieved from: http://www. asthma.org.uk/advice-asthma-attacks
Ayres, JG. et al. 2004. Brittle asthma. Retrieved from: http://ncbi.nim.nih.gov/pubmed/15222953
Severe asthma. Retrieved from: http://asthma.org.uk/advice-severe-asthma
Tidy, C. 2012. Acute severe asthma and status asthmaticus. Retrieved from: http://www.patient.co.uk/doctor/acute-severe-asthma-nd-status-asthmaticus