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Thorax 1998;53:315-321 ( April )

Occasional review

Brittle asthma

Jon G Ayres,^a Jon F Miles,^a Peter J Barnes^b

^a Heartlands Research Institute, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK, ^b National Heart and Lung Institute, London SW3 6LY, UK

Correspondence to: Professor J G Ayres.

The first 150 words of the full text of this article appear below.

	Introduction

The term "brittle asthma" was first used in 1977 to describe patients with asthma who maintained a wide variation in peak expiratory flow (PEF) despite high doses of inhaled steroids.¹ It was coined at a time when patterns of PEF variability were beginning to be described with respect to clinical patterns of disease, such as the morning dip in PEF^1 2 and the "double dip" pattern of morning and evening dips³ seen in patients with less well controlled asthma. The brittle asthmatic PEF pattern of variability was identified as a separate group, being described as chaotic showing no such obvious repeating pattern. The significance of the brittle pattern was not completely clear at that time, although the inference was that these patients had more severe asthma that was, by definition, more difficult to control. Three papers published shortly afterwards showed that this chaotic pattern of PEF could lead to death from an . . . [Full text of this article]

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