Brittle asthma refers to a rare form of severe asthma.
Pathology
It is characterized by a wide variation of peak expiratory flow (PEF), in spite of heavy doses of steroid use. Brittle asthmatic patients had very serious and often, life-threatening, attacks.
Types have been described.
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type 1:
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characterized by a maintained PEF variability despite therapy
e.g. (> 40% diurnal variation 3,4 for > 50% of the time over a period of at least 150 days) despite considerable medical therapy including a dose of inhaled steroids of at least 1500 pg of beclomethasone or equivalent
may have a female predilection
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type 2:
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characterized by acute/sudden attacks that are very severe (often occurring in less than 3 hours without an obvious trigger on a background of apparent normal airway function or well-controlled asthma) 3
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