Editorial
Brittle asthma: fiend or phantom?
| The first 150 words of the full text of this article appear below. |
In the 1970s the introduction of regular monitoring of peak
expiratory flow rate (PEFR) in asthma patients led to the recognition of patterns of variation that had clinical importance. Most noticeable was severe "morning dipping" or diurnal variation which was shown to be a prominent feature in small numbers of patients shortly before
death or successful cardiopulmonary resuscitation from apparently
suddenly worsening asthma.1 2 This phenomenon has
subsequently been attributed to the effects of normal circadian rhythms
in airway calibre on increasing bronchial hyperreactivity3 and the underlying mechanisms are at least partly understood. Turner-Warwick also described another pattern, "brittle asthma", which showed similar large changes in the magnitude of PEFR,
responsiveness to frequent use of inhaled bronchodilators, but a
chaotic pattern of variation.4 Some authors suggested that
asthma patients could die within very short periods of apparently good
asthma control,5 although others debated whether these
deaths were only perceived to be
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