Not much change in peak flow during huge flare up - confused

I've been reading various bits and pieces of previous posts over the last while which mention this but I just wondered if as anyone in same position or can shed any light on this? . My peak flow readings vary very little despite major symptoms. I have almost always been 450 when well controlled and even during a lower lobe chest infection last year it stayed the same. Despite increased SOB and bouts of coughing in last ten weeks my peak flow still stayed steady at 450. I started to doubt it was asthma related until I had an acute attack last week (first ever). The next day I felt extremely poorly , coughing constantly and constantly SOB/wheezy however my peak flow had only dropped to 350 the lowest it’s every been. Makes me think perhaps I'm just very symptomatic for a relatively small drop in PF? I continued to feel really poorly , taking ventolin every 4 hours every day in last week since attack in conjunction with steroid inhaler, course of pred and started on montelukast too. Last 2 days PF has risen to 400 and I've started to feel a bit better but still symptomatic with cough, SOB etc. Chest infection has been ruled out (clear chest / normal x ray). So I guess I'm wondering if its possible for PF to remain quite good for some people during flares ups ie not always a good indicator?? It worries me because when I went to out of hours/ gp surgery / asthma nurse in the last ten days it's the first thing they ask me and its making me think they don't believe I've been that unwell as they seem to place such emphasis on it.

Help!

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I can totally relate to this, my best is 570 and I can be symptomatic but still achieve over 540, other times I get 350-400, but feel exactly the same symptoms. Other times I can get 450 and feel absolutely fine. Unfortunately, this coupled with the fact I don't wheeze makes getting help difficult as I have to argue my case while really struggling to breathe never mind talk. Fortunately when I visited the Gp this morning because I was symptomatic and ventolin wasn't lasting very long, my pf was only 300 despite taking ventolin so I got the neb I needed straight away (still wasn't wheezing though!!) Without having to try and explain anything.

I hope you're feeling better now xxx

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i know the feeling in an attack my pf can be 450 but cannot talk good sats etc and the hospital still cannot understand why but desperate for breath so how do they work that one out lol?

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Thanks Butterfly and Lola, that really helps and makes me feel better! Im beginning to think I'm not a typical asthmatic either, although I say I've been wheezing ,it's more like a ""crackle"" on deep breathing that I can feel and hear that the doctors don't seem to be able to hear themselves. My PF is still at 400, less than my norm yet I feel so much better than I did 5 days ago when I had the same reading! I'm starting to realise I will probably have to plead my case also when I flare up again.

Butterfly I hope you are feeling better. Lola yes exactly, cannot talk but PF OK...think they shouldn't always put such emphasis on it all the time. Xx

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Hi

When I have an attack my peak flow rarely changes. It may prop by a couple of points but nothing drastic. My sats are always good too but I can be really tight chested and wheezy. In recent weeks I have had a tight chest without the wheeze. But peak flow and sats OK. It can be quite confusing at times. I don't always know what is going on and usually end up at the DR Surgery just to be safe.

Hedgehog50

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Peak flow primarily measures large airways flow, not small airways flow. I have small airways disease and my peak flow doesn't change much at all between feeling okay and feeling absolutely lousy. This is apparently because PF measurements pick up changes in large airways which is usual in asthma.

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Thanks Hedgehog50 and nursefurby. Thanks for your input. Feel relieved to have this confirmed as a normal finding for some asthmatics . Nursefurby I read that about large/small airways now you mention it . Is this something that all medics, asthma nurses shld know? When i have been asking for an explanation recently at variius appts etc No one has been able to tell me this when I have asked them why my PF was so normal! X

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I would have hoped so. The difficulty is that 'asthma nurses' are the GP practice's practice Nurse, and as such, asthma clinics are just one part of their role. Unkess they have done a post grad specialist qualification in respiratory issues they won't have specialist knowledge. My asthma nusprse has post grad qualifications in that area so I'm lucky. I certainly would expect respiratory medics to know.

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I hadn't appreciated that about not necessarily having post grad resp qualifications. It really does make me feel relieved actually. Having been so unwell recently with my asthma and feeling utterly awful for a good ten days, I felt the inference on a few occasions was that I wasn't as unwell as I was making out on account of my PF! However maybe I just misread the situation as I think I can at times when I'm not well. I've been referred to respiratory med now, so glad to hear it shouldn't be an issue hopefully when I'm reviewed. X