Are peak flow readings necessarily reflective of asthma condition?

[flossiew]

Hi folks- perhaps I should know the answer to this so please accept my apologies for being a numpty....

My reason for asking is that I woke up wheezing this morning - as is normal for me at some stage (s ) of the day- and have also been coughing and wheezing since-relieved thankfully by my inhaler- yet my peak flow this morning was 410, going up to 440 after taking my seretide 125 (4 puffs this morning due to yet another impending cold and the same again tonight). My range has gone up slightly in recent weeks from 380-390. Also, a few weeks ago when my asthma was the worst it's been yet since my diagnosis in October,(being unable to hold a conversation; walk more than a few steps or even put away an online grocery delivery without being short of breath & coughing etc), yet when I saw the GP my peak flow was the best ever at 460!! Thankfully she realised that the two courses of abx were not helping as she heard me wheezing and she prescribed a 7 day course of pred which helped vastly; but I really am confused. Does anyone have any answers??

Btw- I have now been referred to a specialist as my GP has acknowledged that the treatment I've received hasn't brought my symptoms under control, but I really would be grateful if anyone can shed any light on what's as clear as mud to me at present.

Yours hopefully,

a very perplexed Flossie

[Staceyj1959]

Hi Flossie, after reading your post, I have a similar issue. I've had a flare up this week and back on steroids for 5 days, but my peak flow has stayed within 300-350 which is normal for me...however, I am wheezy and breathless and on 'Monday I couldn't even hold a conversation, but I'm feeling much better today.

My peak flow has increased to 350 now from an initial 250 when diagnosed, I have been a lot better since I've been on Spriva(sp).

I'm still not sure about the whole peak flow thing 🤔 Maybe someone else can give you better information than me.

Best wishes

Stacey ❤️

[flossiew in reply to Staceyj1959]

Hi Stacey. Thanks for getting in touch. I'm sorry that you have been unwell but glad to hear that you have now turned the corner - where would we be without steroids??!

I have tried googling the whole peak flow thing but with little success as most folks seem to see a correlation between low peak flow readings and an asthma flare up- perhaps you and I are the exception to the rule! Anyway, take care

[Hidden in reply to flossiew]

No, you're not, this has happened to me as well and I posted a similar question entitled 'Confused by peak flow readings' four months ago. I did get a few replies, including one or two suggestions. If you click on my name you should be able to access that thread

[flossiew in reply to Hidden]

Hi Maggie. Thanks for the info I'm on nights at present- currently on a bus and looming ahead lies a 12.5 hour shift so I'll probably follow your link in the wee hours of the morning! Have a good evening

[upset]

My pf doesn't always correlate with how I'm feeling. This evening I've been wheezing and coughing non stop and my pf is 450 which is what I've been averaging all week when feeling absolutely fine.

[flossiew]

It doesn't seem to make any sense!! Hope you're ok

[Hidden]

Hi Flossie

Im glad you've been referred to a specialist be clear on your symptoms and your needs.

Take care xxx

[flossiew in reply to Hidden]

Thanks! I'll try my best but I get in a muddle sometimes but I am trying to keep a diary detailing peak flow but also symptoms day to day- when they occur and what may bring them on. Simply walking in the ward this morning I was wheezing then coughing on the tube Anyway, how are you? Think of you often xx

[Hidden in reply to flossiew]

Hi Flossie 🌷🌸🌺

yes they've given me a diary to keep as well! It helps, the peak flow chart and a journal I write how much I take of each inhaler per day I have 3 ventolin, seretide and atrovent.

So the hospital said come in for spirometry when you feel off so I went he said VGM was really low, what's VGM??

Anyway after the 3 times in the cabin with the pinched nose I was washed out so she said take 4 puffs of ventolin with the aerochamber and we waited 10 mn and started again the consultant came in and directed me to empty out my lungs further then fill up more he said and blow hard again! Of course it was a little better but I said if I have to take 4 puffs of ventolin to feel better..

so he said how do you feel now I said honestly I don't think I have asthma. I have those lungs full of cysts and I feel I'm carrying my lungs..for me it's that and you know your own body. Haha I always thought it was coz I had big boobs well one advantage at least^^

Have a lovely day Flossie keep on pumping that vento in and the rest and don't think too much. Hope the weather is nice, I miss England, I'd be at a pub terrace by now having brunch and a shandy!!

Big kiss

Fran ☀️🌻☀️

[flossiew in reply to Hidden]

Hi Fran. That's something else we have in common- big boobs! The weather here at present isn't great so you would need a nice warm coat on while sipping your shandy- mine's a nice cider, a pear one if you're offering! What is VGM btw??? Ttfn, Sandra xx

[Hidden in reply to flossiew]

Hi Flossie hot one day and wet the next here I checked all those spirometry measures thank you wiki and decided you must be a mathematician or a physicist so just tell me what to take doc😃😃

I received the Omron portable Microair I ordered it's a bliss all I need are the nebs!

Have a nice day, week!!

☀️🍰🍡 Fran

[flossiew in reply to Hidden]

I will try my best to have a good week but I am presently on my way to work on a ward where the sister seems to be gunning for me so not much sleep sadly and I have another HR meeting later this week too re the amount of time I have had off sick. Onwards & upwards I guess... Take care

[Hidden in reply to flossiew]

Take the union with you to meetings I had the same problem when I was teaching for Hammersmith and Fulham they sent me to occupational who told them I had a chronic illness and that was that but I found the whole experience humiliating. I was glad to have my colleague there to support me when the deputy-head was passing me through a sieve..but I always went to the GP and paid for a certificate in the end because they were trying hard to get me out..

[flossiew in reply to Hidden]

Hi Thankfully my rep is coming in with me! I alerted her to some indiscrepancies re their reasons for calling the meeting- that although on the two occasions I have been off sick with my asthma (and been signed off as such by the doctors)- HR have classed it as a chest infection which is not a "disability" unlike asthma thus allowing them more scope to come down hard on me. However my rep is on the case and won't allow them to get away with it and will put forward a case that their formal monitoring of the amount of time I have off sick is flying in the face of my newly diagnosed condition Like you I feel they want to get rid of me, but I'm determined to hang on till something else I feel I would enjoy opens up as I get on well with my colleagues and would be sad to leave them...

Anyway, on a lighter note, my shopping arrived earlier today and I managed to put it all away without keeling over! Three bottles of cider are now awaiting the attention of my hubby and I sometime over the weekend

Take good care of yourself xx

[Hidden in reply to flossiew]

Thank you I hope it went well for you. 😊

[flossiew in reply to Hidden]

Put it this way- I have had more fun at the dentist's than at the meeting! I was in tears during it. Really need to consider a move elsewhere- whether in the same trust or a different one as my ward sister is very unsupportive, uncaring and abrasive- that's what my union rep said when she advised me (off the record) to look for another post... A third sickness absence in the next six months will probably result in a second stage reprimand I have been wheezing on and off virtually all day so I'm not very hopeful I can manage!!

[Hidden in reply to flossiew]

Awful when you think they are in the care business. I'd take a lawyer or a reporter I swear it's shameful.

Take care Flossie dear don't let the b..get you down! Xx

[emmasue]

I have the same issue. My peak flows are really good for my size (average 580-620). My asthma nurse says that it is because I used to play brass and woodwind instruments in school (flute, flugal horn, French horn). When I need to use my inhaler more, I tend to get a better peak flow. I assume this is because I am using my inhaler more and focusing on my breathing more. However, I have noticed in a few past flare ups that my peak flow has dropped. Unfortunately, because my peak flow is generally good, my lower readings are assumed to be normal when I go to the out-of-hours or A&E. Once at A&E, I was so bad I was blacking out. My peak flow was 450 and the doctor and nurse said I mustn't be too bad. I think I even burst into tears at one point because the doctor wasn't taking me seriously. I don't think emergency doctors have a good understanding of asthma and how it presents. It is something that does worry me.

[Hidden in reply to emmasue]

It's more to do with the fact that doctors too often fall into the trap of ignoring variables. When I was pregnant with my second child we had an appalling tussle with one doctor (a registrar in obstetrics). He was convinced that I was 38 weeks pregnant when in fact I knew I was 42 weeks. The reason for this: he was going by the scan which stated (on the basis of measurement of various limb bones of the baby) that I had conceived one month later than we thought. This was despite the fact that there was no way the pregnancy test I had used would have come up positive if I had conceived a month later. The problem, which my husband (with a doctorate in sciences from one the world's top five universities) had spotted when the scan was done, was that the person who did the scan had reached the due date by looking at the average, rather than taking into the consideration possible variations (which placed the baby in the bottom 2% for a foetus of the age we had stated). Had that doctor had his way I wouldn't have been seen for another two weeks (when I would have been 44 weeks pregnant!). We protested and asked for a second opinion from a consultant. As a result I was induced at 43 weeks, and despite what the doctors were predicting the baby was born six hours after the medication to get me going was given. When he arrived the senior midwife in charge immediately declared him obviously 'very overdue'. Nor was he even small. He was average in size, not even near the bottom 2%.

Apologies for the fact that this story has nothing to do with asthma, but it does demonstrate how appallingly bad far too many medical professionals are at basic statistics, despite the fact that in order to train they must have achieved top grades in maths at school. One has to wonder at what is wrong with their training. Either they just don't seem to want to consider the possibility of variables or they don't understand the principle, neither of which is satisfactory.

Sorry for the rant, but it is depressing to hear that this sort of basic error continues to be made.

[flossiew in reply to Hidden]

It does make the mind boggle especially when folks who are meant to know what's what don't seem to have a handle on things themselves! I just hope that when I see the "airway" consultant he/she will know what's up with me and treat me accordingly. I am going with peak flow diary and symptoms etc clutched in my hand and hopefully they'll be able to make some sense of it! Glad to hear that despite people's ineptitude/ blinkered vision that there was a happy outcome for your family

[emmasue in reply to Hidden]

I had a similar experience with my daughter where I was probably a week further along than the scan said. Fortunately she came on her "due date" so it wasn't the problem you had. I am glad you and baby were ok.

We had a similar issue with the growth charts in my son's and daughter's red books. Because the charts were based on formula fed babies and I breastfed mine, my babies were both on the small side. Fortunately the midwife found a breastfed baby chart and it turns out the kids bith grew normally. It is an issue if doctors rely on dodgy charts (bmi for instance) to judge a person's health and not on common sense and continuity of care. 😛

[flossiew in reply to emmasue]

It's sad that so many folks -yourself included - have not received the care needed when in A&E. But even my asthma nurse was puzzled when I told her what my peak flow was on my worst ever day with asthma- confusion reigns...or so it would appear Take care xx

[-Butterfly- in reply to emmasue]

I have an abnormally high best pf too, mine is 570, played a brass instrument when growing up too.

So mine is around 450 at the minute which is around what my predicted is but actually less than 80% of my best.

I work in a hospital where I have to analyse numbers as part of the test I do. I have 'normal' values that I use, but always report if the patient experiences symptoms even if their numbers are 'normal' as I know ' normal ' isn't a one size fits all.

[Hidden in reply to -Butterfly-]

Pity front line medical staff in A&E (or working out of hours) don't always do likewise. In the case of asthma it takes just seconds to ask 'what is your normal peak flow reading?' Not a difficult question to ask, and you would think anyone with a certain amount of common sense and of reasonable intelligence would understand the importance of doing so.

[-Butterfly- in reply to Hidden]

It's not difficult and it means so much to the patient. I always caveat before blowing into the pf meter, that my best is 570!

Unfortunately these people are extremely clever but sometimes common sense just can't be taught! I see it a lot at work, highly trained medics telling me something and I'm just like 'are you for real?'

[Hidden in reply to -Butterfly-]

From what I can recall, the words 'extremely clever' were not used by my husband to describe the registrar in obstetrics when we were having the tussle over my second child. He was rather more scathing - and he is someone who really is 'extremely clever'.

[Alliecat]

I have found a lot that my peak flow doesn't necessarily reflect on how my asthma is.. my peak flows can be pretty low when well.. (around 250..)... but then I have felt bad when its been a bit higher (270) no idea how this works.. will talk to my consultant about it next time I see him!