Brittle asthma: what you should know

The term is used for asthma that remains difficult to control or can deteriorate quickly despite treatment. Symptoms may include wheezing, cough, chest tightness, and shortness of breath. Triggers can include infections, smoke, exercise, allergens, and irritants; allergic rhinitis and house dust mite allergy may add to airway symptoms. Some people have few warning symptoms before breathing becomes seriously restricted. A clinician may review inhaler technique, daily control, peak-flow patterns, triggers, and other conditions such as chronic cough before refining the diagnosis and plan.

Use preventer and reliever medicines exactly as prescribed, and check technique with a healthcare professional. Keep your written asthma action plan accessible, including the steps for worsening symptoms and when to call emergency services. Track symptoms, reliever use, peak flow if advised, and exposures that preceded flare-ups. Avoid smoke and known triggers. Specialist review may be needed when attacks recur, treatment is hard to follow, or symptoms remain uncontrolled; nebuliser treatment may be used in urgent settings when a clinician considers it appropriate.

Call emergency services if you are struggling to speak in full sentences, becoming exhausted or confused, developing blue or grey lips, or getting rapidly worse. Follow your action plan for severe wheeze or breathlessness and do not delay because symptoms briefly improve. An attack that is not responding to your reliever as directed needs urgent assessment. Sit upright while waiting and take medicines only according to your prescribed plan.

What features make my asthma high risk? How should I use my action plan during a sudden change? Should I monitor peak flow? Could allergy or chronic cough be affecting control?