What is more important? Peak flow readings or asthma symptoms, not severe ones.

[Wheezycat]

I am baffled, and I hope someone out there could explain. Recently I had a run-in with an inscence stick. It really didn't agree with me, and the day after the encounter I woke up feeling I was getting a chest infection. I wasn't and very gradually the asthma sensations/symptoms wore off, over nearly 10 days. Throughout this time my peakflow didn't vary much at all, nothing to cause concern.

On day two after my inscence stick encounter I contacted the very helpful Asthma UK nurses, still feeling rough in the breathing department, and asked for advice. She told me to immediately act on it, which I did. I got permission to take a bit more symbicort than usual. (I am now on SMART regime).

What I don't understand is why the importance to act, when the peakflow was fine, even though I felt rough? The asthma UK nurse was pretty emphatic about it. It was a relief to me, but if I had followed my own logic, I would have said as long as my peakflow was fine then there was no problem in spite of how I felt.

[Michowls2]

I'm currently in hospital after an attack on Wednesday symptoms of tightness started Sunday but I put it down to hay fever and as result the attack was bad with itu involvement. Even so during my time in hospital my peak flow isn't that bad but has improvements after nebs. One thing the dr have said is to treat the patient not the numbers and thank god they have. Hope you feel better and this helps

[Egret_J]

I find that if I don't act immediately at the start of a reaction it is more likely to worsen and be a lot harder to control. Perhaps the nurse was concerned you were at risk of a further exacerbation of symptoms.

[Beth_19]

From what I gather from having talked with my consultant, peak flows measures what the large airways in your lungs are doing. They can relatively be fine meaning your peak flow remains the same but the smaller airways are irritated causing the asthma symptoms.

I watch my peak flow but tend to go more off how I feel because I've always had a good peak flow even when poorly.

[hb1977]

Hi I used to go on peak flow alone; sometimes this drops to around 50% of best, sometimes it's not as low as that and stays around 62% but I still need lots of Salbutamol. Was speaking to a specialist asthma nurse this week who told me to pay more attention to symptoms than I currently do!

[risabel59]

I used to be really hung up on my peak flow Diary with charts and numbers and the whole shebang. Then my consultant in the US said he wanted me to stop the diary for a while because he wanted me to be more reactive to symptoms. Use of Ventolin. Night coughing, wheeze etc. now newish consultant has asked me to keep a very detailed diary for a while. But I actually base my step up approach on symptoms as well as peak flow. I find night waking with coughing a major indicator that things are going pear shaped. I think that all the tools that allow you to get ahead of the curve in terms of treatment before ending up in a&e are a good idea. But after you've had asthma for a while I think you pretty much know when things are going downhill. Or at least I do.

That's my take on it.

Glad you managed to control incense impact.

R x

[Wheezycat in reply to risabel59]

I seem to be answering the replies in the wrong order....thus a bit confusing.

My asthma worsened significantly last year, with a nasty chest infection where I ignored the symptoms, and didn't even notice all (like for a period not being able to speak a whole sentence without being needing to breathe in the middle.) in the end I ended up in hospital. Since then on better medication (SMART now) which has made a lot of difference. But I am still learning what affects me. Fumes, smoke, some smells are significant. They didn't used to be. But I still don't know exactly.

All your replies have been really helpful even if I read and responded in the wrong order. I am learning from your experiences. Useful learning. And I had forgotten about fine airways.

Thank you to all of you.

[ErnieErnie in reply to Wheezycat]

Hi i seem more sensitive to triggers now than i used to be my theory is that at 47 ive probably got quite damaged airways.

[Wheezycat in reply to ErnieErnie]

I am far more sensitive to all sorts, like smoke, inscence, oil based paint (the latest), Pledge, lo fresheners, and I really notice smells far more, even if they don't ultimately cause me problems, like aftershave and perfume worry me when I encounter them, but they haven't in truth caused issues.

[Wheezycat]

Thank you both for your replies. It is true I was rubbish at noticing my own symptoms - or if I did I blamed it on unfitness and general feebleness. Now I know better. However, though I agree with you both (and by gum am I trying to learn! Hyperattentive these days! ) it still does not clarify for me why I need to bother with symptoms if my peakflow is fine. I don't any longer keep regular peakflow, only check it if I feel symptoms, but then my pf is fine even if my lungs feel rough. I can feel irritation from various kinds of fumes for instance, but my peakflow is normal. So still don't understand.

[Wheezycat in reply to Wheezycat]

Ah, fine airways! Now that would explain some things!

[Superzob]

I'm sure I saw an explanation for this somewhere on the forum, but it would be difficult to find it now. Does anyone else recall?

[Wheezycat in reply to Superzob]

Yes, i am also interested Learning more. There is some on the net, but more info from experienced asthmatics would also be interesting.

[Superzob in reply to Wheezycat]

Found the previous post (and the answer). Seems that peak flow measures the larger airways and the smaller ones might still not contract sufficiently. This is probably not surprising as the measurement is only over one second, so the air in the alveoli probably doesn't have much time to move; consequently, it doesn't figure on the peak flow volume. Thus you could have effective large airway exhalation but still have asthmatic effects from small airway constriction. Presumably, spirometry will pick this up as you exhale over a longer period. Don't know how accurate this is, but certainly sounds plausible.

[Wheezycat in reply to Superzob]

I agree.

[ErnieErnie]

My peak flow is good 750-700 even when my asthma is very bad or i have a chest infect it does not measure the inflammation which is the real test of how i feel.

[Wheezycat in reply to ErnieErnie]

You, like others, seem to say this. It is helpful to know. Last year I got really ill, the final end result of a chest infection, but then my peakflow really went down. Now I am learning how to assess my own health. As I was crap at noticing I had a problem, I am having to learn to trust my own judgement, so hearing all these different experiences is good.