peak flow

[Carriejen]

Anyone noticed sometimes they are tight chested, peak flow still classed as 'green' and salbutamol helps, but sometimes doesn't last the 4 hrs? I've been advised that as my peak flow hasn't dropped more than 20% I shouldn't be using my inhaler as its likely not asthma causing the band around my lungs.

[ReedB]

It's a tricky one as I don't know your history but I'm an asthmatic who's peak flow only has to drop a tiny percent and end up in trouble. My best is 520 if I'm struggling to hit 480 I know its time to up my meds then if it's 450 and below I'm usually on prednisolone.

If you're seeing improvement from taking the blue inhaler then surely it's asthma related? Do you know your triggers? If it's allergies then may help to take antihistamines too?

Either way if the salbutamol helps then you can take more than every four hours but obviously if you're ever struggling to breath or not getting any better seek more help. One last thing, sometimes we can get tight chested from not breathing properly. Take some time to pause and take deep breaths it may help. Xx

[Carriejen in reply to ReedB]

My peak flow doesnt really tend to drop until I'm really tired or actually ill as in have an infection. Last time I had a chest infection it was down at 360 and the doctor at the hospital sent me home saying I'd be fine as average for my age/height was 416. My best is 500! It's been up and down this past 3 weeks, ranging everywhere between 390 and 500 which i am assuming is hayfever even though I've never been badly bothered by it before. I'm not using an excessive amount of salbutamol either just sometimes it takes 3 puffs to make me feel better and then within an hour sometimes it gets bad again and I need some more. Im actually using my spacer now which is definitely helping

[Poobah]

Yes, some days I find myself reaching for my Ventolin even when my PF hasn't declined. My asthma nurse is against using Ventolin more than 3 times a week, however, I find sometimes I need it to help me get to my evening dose of combo inhaler. Right now with the tree pollen season in full flow I'm more wheezy than usual so have increased my Fostair which has certainly helped.

The thinking of respiratory experts is that Ventolin, if used too much, starts to have a negative effect on the lining of the lungs. Hence the efforts to get patients onto a meds regime that avoids the regular need for Ventolin.

If you're finding that Ventolin isn't effective after a couple of hours then maybe consider upping your other meds rather than increasing your Ventolin intake. If that doesn't work then time to have an asthma review with your asthma nurse.

[Carriejen in reply to Poobah]

At the moment my peak flow is between 390 and 500 when my personal best is 500. So it is changing, and I am assuming that is to do with hayfever. I am on fostair and taking 2 puffs morning and evening. The tight chest seems to be worse when I'm outside or when I have the window open (hence thinking hayfever) im not sure whether to take more fostair through the day? I cant get an appointment at my surgery as as soon as I mentioned I had a tight chest and a slight cough they tell me to assume it was covid 19. I've tried twice in the last fortnight and they wont listen when I say it's an asthma issue

[Poobah in reply to Carriejen]

I'm on Fostair 100/6 and currently taking 2 x 2 puffs a day. Asthma nurse said I could take a maximum of 8 doses under SMART.

I have only recently increased from 3 puffs a day and the extra dose has really helped.

[Carriejen in reply to Poobah]

I'm on 200/6, plus montelukast and spireva. I think I'll maybe see if I can get a phone consultation to see if I can up it from 4 puffs! Thank you

[Hidden]

In some people peak flow is not a good indicator as it remains “green” until they are very poorly-so you should let your asthma nurse know abd develop an action plan that takes that into account

[Carriejen in reply to Hidden]

My peak flow doesnt really tend to drop until I'm really tired or actually ill as in have an infection. It's been up and down this past 3 weeks, my best is 500 but it's been everywhere between 390 and 500 which i am assuming is hayfever even though I've never been badly bothered by it before.

[Lysistrata Administrator Community Ambassador]

If the reliever inhaler is loosening the band and making you feel less breathless then I would suggest it is likely to be asthma. As others have said peak flow isn't everything, and you can still be having asthma and need your inhaler without it having to drop loads.

I can take my inhaler when symptomatic in 'green' zone and get a significant amount of reversibility between the peak flow pre and post, above the level they use to diagnose asthma! So yes it may have been green to start, but if it reverses that much I would say it was asthma nonetheless.

I also agree with others that you need to keep an eye on this if your reliever isn't lasting. I get that (it wears off more quickly) when my asthma is worsening so if it is frequent then you may want to check in with your GP or asthma nurse (or did you already and they told you it wasn't asthma? You might have to persist - look up AUK advice maybe to discuss with them?)

You might need an increase or change in preventer meds if it keeps happening. As Poobah says ideally you shouldn't need reliever more than 3x a week. However that's about needing it not using it - if you are finding you need it more than that then it's a sign of poor control and your treatment needs to be reassessed.

[Carriejen in reply to Lysistrata]

My gp has told me once that I dont have covid 19 when I went in with asthma issues and the second time got me to phone 111 and she assumed it was covid. Neither time did I get the option to speak with my usual asthma nurse. Im assuming that its hayfever causing my issues, as salbutamol does help, but on a different forum I was told I shouldnt be using my blue inhaler if my peak flow was still 'green' which for me it has been. Its been between 390 and 500 over the last few weeks which to me indicates theres an asthma problem and not, as suggested, an anxiety problem?

[Lysistrata Administrator Community Ambassador in reply to Carriejen]

Ugh why are people so quick to jump to anxiety? I would agree it sounds more like asthma with the salbutamol helping and the hayfever element. Plus peak flow variability in itself can be a sign your asthma isn't that well controlled.

I would be inclined to ignore whatever they said on the other forum - especially if that wasn't even a professional! (Ok neither am I or others here, but we are basing it on validated advice. Assuming green peak flow is anxiety not asthma despite other factors is not validated AUK advice).

Tricky to know how to deal with the GP issue. Is there one that you know is good, and are you able to make an appointment, even if just by phone, with one you trust? The AUK line is quite busy but may also be worth a call as they are usually helpful with practical issues about GPs etc too - may have to wait a bit but could be worth a go?

[twinkly29 in reply to Lysistrata]

I agree with all of this.

A friend was told by a paramedic that her asthma attack was anxiety because her peak flow didn't drop - her peak flow never ever drops. Her GP was not impressed the following day as she was still really wheezy and said it absolutely wasn't anxiety and definitely asthma.

[Carriejen in reply to twinkly29]

I dont have a wheeze either, but I have a definite feeling of a band around ny chest. I havent had any real bother with hayfever before that I an aware of, I've never really noticed trends or anything but I have what seems to be a very very mild cold combined with a regular mild cough, no temperature, and a band around my chest. I think I'll see if I can get a phone consultation with my asthma nurse! Thank you both

[twinkly29 in reply to Carriejen]

I don't wheeze. Definitely have chest tightness and heaviness though.

[Lysistrata Administrator Community Ambassador in reply to Carriejen]

Ditto - no wheeze usually and a fairly unhelpful peak flow, just to make everything more fun! I get a fair bit of 'are you sure it's asthma/it can't be asthma'. Yes it is, because there's more to asthma than a one off PF number and a wheeze!

Hope you get somewhere with the nurse.

[Carriejen in reply to Lysistrata]

I haven't phoned yet, I'll try tomorrow. I spend a lot of time doubting I have asthma because I have only had one big attack, I get regular chest infections but have only had one really bad one, and because my peak flow doesn't tend to drop until I am very ill. This advice I got just upset me yesterday. My blue inhaler helps, it brings my peak flow back up, but often is needed again a while later. I have only just started taking an antihistamine as the one I was previously on didn't make any difference. Thank you all for making me feel better

[ReedB in reply to Carriejen]

Carriejen you sound just like me! It's very frustrating at times but remember you know yourself better than anyone. I hope you can get to talk it through with your regular nurse/gp. Have you taken telfast/fexafenadine before?

[Carriejen in reply to ReedB]

No I've never had either. Usually my fostair, montelukast and spireva helps manage my asthma. I've never been bothered with hayfever this badly, thoughts morning I woke up all stuffed up and couldnt breathe! I'm not sure if its hayfever or just a really long lasting cold I have.