Find a Doctor Find a Doctor
Time to see a specialist? Time to see a specialist?
We found [COUNT] Specialists
who treat [INTEREST]
We found [COUNT] Specialists
who treat [INTEREST]
[TELEHEALTH] offer Telehealth options.
Controlling Severe Asthma

This content is created by Healthgrades and brought to you by an advertising sponsor. More

This content is created or selected by the Healthgrades editorial team and is funded by an advertising sponsor. The content is subject to the Healthgrades medical review process for accuracy, balance and objectivity. The content is not edited or otherwise influenced by the advertisers appearing on this page except with the possible suggestion of the broad topic area. For more information, read the Healthgrades advertising policy.

Understanding Brittle Asthma

Medically Reviewed By William C. Lloyd III, MD, FACS
Was this helpful?
senior man using inhaler while exercising at gym

Over 25 million Americans live with asthma, a chronic lung disease resulting from inflammation and extra mucus inside the airways. There are several different types of asthma, and most can be successfully managed with a combination of lifestyle changes, avoiding triggers, and medication. However, one form of asthma, brittle asthma, can be more difficult to treat.

Brittle asthma is a rare type of very severe, often unpredictable, asthma. This condition isn’t common—but if you have brittle asthma, you’ll want to know how you can stay as safe and healthy as possible. Working with your doctor to develop a treatment plan for brittle asthma is the best way to protect yourself.

The Basics of Brittle Asthma

Unlike other forms of asthma, which may be easier to control, brittle asthma is typically much harder to predict. People living with brittle asthma experience asthma attacks in which the airways inside the lungs swell and, in some cases, close. For many, this inflammation is also accompanied by increased mucus, which may make breathing that much more difficult.

This unstable condition may be very difficult to manage with standard asthma treatments. In many cases, people living with brittle asthma must receive professional medical care during flare-ups. People with brittle asthma will need to stay in touch with their doctor more regularly and will likely require higher doses of their medications to find relief.

Types of Brittle Asthma

There are two types of brittle asthma:

  • Type 1 brittle asthma: Doctors diagnose type 1 brittle asthma if you have wide fluctuations in your peak expiratory flow (PEF) rate throughout the day. These fluctuations occur even though you take the maximum amount of asthma medication your doctor prescribes.

  • Type 2 brittle asthma: If you have type 2 brittle asthma, you’re more likely to experience sudden and extremely severe asthma attacks. Without immediate medical attention, these attacks may be fatal.

Causes of Brittle Asthma

Doctors don’t know exactly what causes brittle asthma. But it’s thought that many of the same risk factors for less severe forms of asthma can increase your risk. These risk factors include:

  • Cigarette smoking

  • Exposure to asthma triggers, such as pollen, fungal spores, or certain foods

  • Genetic mutations

  • Obesity

  • Other conditions, such as respiratory infection or sinusitis

  • Psychological problems, such as depression and anxiety

Research shows that women, especially those between the ages of 15 and 55, are more likely than men to be diagnosed with type 1 brittle asthma.

Brittle Asthma Symptoms

People living with type 1 brittle asthma may experience a range of symptoms similar to less severe forms of asthma. These symptoms include chest pain or tightness, shortness of breath, and wheezing or coughing fits.

People with type 2 brittle asthma experience the same symptoms, but they come on extremely quickly and unpredictably. Those with type 2 brittle asthma may be symptom-free for months or years and then experience a severe asthma attack requiring help from a doctor.

Treating Brittle Asthma

Treatment for brittle asthma is generally more difficult, since many patients already take the maximum amount of asthma medication allowed each day. You may already take high doses of inhaled corticosteroids and bronchodilators, and you may think you’ve run out of options. But it is still possible to find ways to manage your condition. Treatment for each type of brittle asthma centers around controlling symptoms and avoiding known asthma triggers.

If you have type 1 brittle asthma, your doctor may supplement your existing treatment with other medications, such as oral steroids. Your doctor may also recommend ways to reduce your exposure to known asthma triggers, including making changes to your diet and changing your daily routine to avoid environmental triggers. In more severe cases, treatment with injectable medications may be necessary to control your symptoms.

Because type 2 brittle asthma is a medical emergency, treatment takes place at a hospital or other healthcare center. Generally, the first line of treatment involves injecting adrenaline, a hormone also known as epinephrine, into the patient to bring symptoms under control. Once symptom control is achieved, your doctor will help you determine next steps.

Brittle asthma isn’t a common condition. But for those who have brittle asthma, it’s important to follow your doctor’s recommended treatment plan as closely as possible to prevent asthma attacks. If you have asthma and are concerned about your risk for brittle asthma, talk with your doctor about further testing that could help diagnose this condition.

Was this helpful?
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 May 14
View All Controlling Severe Asthma Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Asthma. Mayo Clinic.
  2. Asthma Facts and Figures. Asthma and Allergy Foundation of America.
  3. Brittle Asthma: A Separate Clinical Phenotype of Asthma? Indian Journal of Chest Diseases and Allied Sciences.
  4. Brittle asthma. European Review for Medical and Pharmacological Sciences.