Brittle Asthma: Still on Board?

Area of Science:

• Pulmonology
• Clinical Medicine
• Respiratory Medicine

Background:

• The term "Brittle Asthma" described a life-threatening asthma phenotype in the early 2000s but has since fallen out of use.
• This review revisits the historical concept of brittle asthma to assess its potential relevance in contemporary clinical settings.

Purpose of the Study:

• To explore the historical definition and characteristics of "Brittle Asthma."
• To evaluate the applicability of the brittle asthma concept to current asthma management strategies.
• To determine if the term can provide new avenues for patient stratification and improved disease control.

Main Methods:

• A non-systematic literature search was performed using Medical Subject Headings (MeSH) and free-text terms.
• No restrictions were placed on study design or publication type to ensure comprehensive data retrieval.

Main Results:

• Current data on brittle asthma are scarce, with few available studies.
• Historically, brittle asthma was sub-classified into two types: one with wide peak expiratory flow (PEF) variability despite high-dose treatment, and another with sudden attacks in patients with seemingly controlled asthma.
• Defining characteristics and prevalence data for these sub-classes remain limited.

Conclusions:

• Asthma severity and control are currently defined by various terminologies.
• Re-evaluating the historical concept of "Brittle Asthma" may offer valuable insights for patient stratification.
• Investigating this phenotype could lead to improved management strategies for severe or difficult-to-control asthma.