[The brittle asthmatic and the morning dipper]

The terms 'brittle asthmatic' and 'morning dipper' were first used by Turner-Warwick in 1977. Since then, the issue of brittle asthmatic is that all attempts to stabilize lower readings in peak expiratory flow (PEF) with regular beta 2-agonists, such as slow compound, oral preparations, or combinations with theophylline seem to fail, although they are rapidly reversed by inhaled beta 2-agonists. In brittle asthmatics regularly treated with a long-acting beta 2-agonist and a sustained-release theophylline, an oral cysteinyl leukotriene antagonist, pranlukast, almost completely inhibited a chaotic pattern of PEF readings. Thus, I suggested that the lower readings might depend on a transient release of cysteinyl leukotriene. In addition, I showed that a long-acting beta 2-agonist, tulobuterol tape, significantly improved a morning dip in PEF readings.