Severe Asthma is Different Disease

Severe asthma is a term that is commonly used to describe patients with refractory, brittle, near fatal and difficult to control asthma. Patients with severe asthma typically experience persistent symptoms, despite medical therapy, report decreased quality of life and suffer accelerated loss off lung function. The roll of genetics, environmental exposure and infection in the development of more severe asthma is the focus on ongoing research. While pathologic changes in these patients are now believed to involve the lung parenchyma (alveoli) in addition to large and small airways, the independent contribution of each off these compartments to the severe asthma phenotype is not well defined. The clinical evaluation of severe asthma should include investigating conditions commonly associated with severe asthma, such as gastroesophageal reflux disease, vocal cord dysfunction and rhino sinusitis. In addition advanced imaging techniques, measurements of exhaled gas or sputum indices and airway biopsy are tools that may aid severe asthma in the near future. Management of patients with severe asthma requires a comprehensive approach that includes non - pharmacological and pharmacological measures. Combination anti - inflammatory and long lasting brochodilator therapy remains the mainstream of management.

Mild asthma, which responds well to treatments may be a completely different disease than severe asthma. An investigation in Europe found that people with severe asthma where 15 - 20 times more likely to need emergency care, than those with mild or moderate asthma. Severe asthma has a huge impact on Health care costs. The five year survival of people with severe asthma is as poor as several forms of cancer. Recent studies find that severe asthma patients where much more likely to have frequent asthma attacks and a poor quality of life, despite the fact that they take large doses of inhaled steroids. Severe asthma patients have different levels of chemicals in their blood, suggesting that severe asthma is a distinctly different form, rather than simply more severe asthma symptoms. As yet there are undiscovered mechanisms that cause severe asthma and more research is needed to improve diagnosis.

Asthma rules the lives of severe asthmatics. Asthma symptoms in these patients are continuous. They have frequent night time symptoms and the level of activity in these patients is extremely limited.

Brittle asthma is an extremely rare form of the disease that is unpredictable. It is rare, effecting only one in 2,000 asthmatics. Brittle asthmatics experience, sudden, very serious and often life threatening attacks. This can occur in spite of taking heavy doses of medication. Many will be on regular doses of steroids, nebulizers and bronchodilators.

Type one brittle asthma asthma is patients who constantly show wide variations in peak flow readings despite medical therapy. These patients are typically female. Type two brittle asthma seems to be well controlled between attacks which are often very sudden in onset and are associated with loss of consciousness on at least one occasion. These patients are very likely to exhibit a severe respiratory acidosis in an attack. This type of brittle asthma occurs equally in men and women. Type one brittle asthma is a cause of considerable morbidity and hospital admissions and results in high doses of medications. Side effects of this medication are very common and include,osteoporosis, weight gain and esophageal reflux. In addition, this can result in obstructive sleep apnea which may remain unsuspected because poor sleep quality tends to be attributed to asthma, even though the symptom pattern is exactly the same in these patients compared to associated sleep apnea. Sleep apnea is treated with positive continuous airway pressure.

Risk factors for severe type one brittle asthma is atrophy (allergy). Over 90% of these patients have allergies and a third keep pets at home. Food intolerance effects over 60% of type one brittle asthmatics and they report one food or drink that makes there asthma worse. Wheat and dairy products also effect 50% of brittle asthmatics. Psychosocial factors are also important in type one brittle asthma. There are high reports of depression, broken relationships and physical abuse in these patients. Just as common are abnormal coping strategies for managing deteriorating asthma. It is difficult to be certain if brittle asthma is associated primarily with personality disorder, or whether severe asthma induces psychological instability.

These patients are, by definition, extremely difficult to manage. Many of then will have fallen out with there Doctor, perhaps understandably, has run out of ideas and often patience. Management should be holistic, trying to approach all ideas which impact on an individuals symptoms. This involves trying to identify all the factors before wrestling all the medicine. Removal of animals from some patients is a must and to identify allergens and food intolerance. The most important factor is the none compliance of treatment. This its self does not cause severe asthma but lots of asthmatics opt not to take treatments because of the side effects and usually they make not much difference to their condition. Many asthmatics take too much inhaled medications. This is because they are extremely breathless most of the time and also at night. This can also cause side effects.

Management of type two brittle asthma is less difficult. In view of a rapid attack each patient should carry a medical alert bracelet. Again identification of triggers is crucial but the mainstream therapy is adrenaline. Adrenaline may have advantages for these patients as it reduces edema in acute airway narrowing. Rapid recovery is the usual response with adrenaline. Conclusion: Patients with either Brittle asthma type one or two pose difficult and complex management problems. Helping to determine these patients will provide a framework for beginning to unravel aetiology and treatment for this high morbidity group.

Studies from asthma deaths and patients with near fatal asthma have concluded that there are factors associated with the disease. Inquiries from 200 asthma deaths show that medical management and patients behavior or psychosocial status contributed to their deaths. Most of the people who died had Severe asthma. In very few patients with mild asthma did the attacks happen suddenly. Some of the deaths occurred in patients who had received inadequate treatment and monitoring of there asthma. Some of these patients where not even under specialist care.

Risk factors for death from asthma are previous or near fatal attack. Admission to hospital within the last year. Requiring three or more asthma medications. Brittle asthma. Compared with controlled asthmatics, patients who died had more severe asthma symptoms continuously. Health care professionals must be aware that patients with severe asthma with one or more risk factors are at high risk of death. Compared with those who die, those with fatal asthma where significantly younger. There are very many similarities in people who die and patients with near fatal asthma.

Some information found onwww.asthma.org.au