Qvar and peak flow

[AirIsUnderrated]

I'm 12 weeks post-viral and have not been diagnosed with asthma. I (still) have breathlessness and itchy chest. I was given salbutamol 8 weeks ago and a trial of Qvar 4 weeks ago.

I had an off-the-record chat with the respiratory nurse at the GP's where I work (not where I'm registered) last week. She said I should be using the peak flow meter before and 20 minutes after taking the Qvar, not the salbutamol as I have been doing. She said if there was no difference in the reading, the Qvar is not helping. Well if anything, the PF reading is going down slightly. But does it "work" that quickly? I know salbutamol does, but I thought Qvar was a long-acting steroid that took up to 4 weeks to kick in. How can it change my reading in 20 minutes?

I'm still confused over PF readings. I don't know how to measure what it ought to be, as all the info says to take readings when my breathing is good to get a baseline reading. But it hasn't been good - that's the problem. For my height/age it should be 400 but I have managed 460 after salbutamol. I can feel pretty good first thing and blow 390, and tight and squeaky in the afternoon and blow anything between 360 and 420.

Am I just overthinking this? The GP wants a pretty chart to look at. Maybe all this is just showing that Qvar isn't helping...?

[twinkly29]

The Qvar will take a few weeks to kick in properly, as a new drug, but should be working by now. You're right that it is a steroid inhaler. I think the idea is that the steroid reduces any inflammation that's going on and ongoing reduced inflammation would increase your peak flow generally.

The peak flow before salbutamol and 20 mins after will show if the salbutamol is helping "in the moment".

Doing your peak flow regularly with the Qvar will show if your general peak flow has increased over the time you've been on it.

The "what you should get" is only a guide - as you've discovered yours can be beyond that. Some people have a much lower norm than expected and some have a much higher one. For now I think they'll be more interested in the change, or not, with the Qvar. There doesn't look to be too much variation in your readings which is good. Your lowest you mention above (360) is 86% of 420 (am assuming that's pre salbutamol), which would be well within a "good" range.

Not sure if any of that helps 😅 - others may well be able to help more than me!

[EmmaF91 Community Ambassador]

As twinkly29 has covered most of it I’ll just reiterate...

With PF you want to measure it twice a day (recording best of 3), either always pre meds or always the same amount of time post med. This will show you control over time, so if the qvar works you should see a gradual increase until it’s fully kicked in if it is helping. To see if ventolin is helping you do pre, and then 15-20 mins post dose, which should show any reversibility. Qvar is a ‘slow drug’ so won’t necessarily show an immediate change after use, whereas salbutamol is a ‘fast drug’ so you should see the difference if it’s helping.

If you work out your personal best PF, typically you are viewed as ok/controlled so long you stay above the 70-80% mark of that score (varies person to person, and team to team, I use 75% as my green/yellow boundary, others 80%, others 70%) and have no other symptoms (symptoms waking at you at night/ made worse by exercise etc etc). It’s not unusual to have a best higher than predicted as many factors can affect best (case in point my best is 630 but I’m predicted 440), and does not directly relate to how asthma is classed (my friend with no resp condition, also predicted 440, best is 300)

Hope this helps

[AirIsUnderrated in reply to EmmaF91]

Thank you, both of you. So can I just get this straight?

The personal best PF is my best score after salbutamol, right? My 460 was after salbutamol and I only got that high once. Even 360 (lowest before Salamol) over 460 (highest after Salamol) is only 78% which is not in the worry zone.

For how long do I have to have "no symptoms" to be classed as controlled? Because without salbutamol my chest is tight and itchy with a squeaky cough all the time I'm awake. Salbutamol relieves it for a few hours, maybe 2 or 3, leaving just soreness. Then it gets more laboured than it had been before I took the salbutamol for maybe another couple of hours. Then it goes back to "normal" tight and itchy again if I don't take any more. I'm trying not to take salbutamol because I prefer feeling predictably uncomfortable to the highs and lows. Or maybe that's normal, and salbutamol is about life-saving not comfort. I'm absolutely not at the life-saving level.

The more I'm comparing my experiences with other people's descriptions, the more I'm thinking what I have is not asthma. Maybe I ought to try the desloratidine after all, despite having side effects many years ago. (I remember making a complete pig's breakfast of an art O.level exam because I was streaming, sandy-eyed, spaced-out, drowsy, dry-mouthed, and there is no way I would work on a telephone help desk like that.) I just wish I could see someone and have a proper consultation! Phone calls only work up to a point. This is hard.

Thank you everyone for all your patience with me.

[twinkly29 in reply to AirIsUnderrated]

I'll leave Emma to answer your peak flow question as she's more knowledgeable with regard to that - but an antihistamine would be worth a go even just to rule it out. But....if desloratidine affected you before, could you maybe try cetirizine instead (also non drowsy)?

[AirIsUnderrated in reply to twinkly29]

I honestly can't remember what I was taking at that time. I know I tried Piriton (Chlorphenamine), Zyrtec (Cetirizine) and Claritin (Loratadine) for severe hay fever. At best they did nothing. At worst they did nothing and I got side effects - good times! But that was a loooong time ago and things have improved since then. Meds aren't quite so sledgehammer-to-crack-a-nut as they were in those days. Plus I'm bigger and in general healthier now. I suppose it's worth a try, isn't it?

[twinkly29 in reply to AirIsUnderrated]

I reckon it is...and hopefully any effects, bad ones, would be short lived....😬😅

[Gwalltarian in reply to AirIsUnderrated]

Ask the GP to prescribe Fexofenadine

[Smoggy1990Boggy]

How are things now? It may be worth phoning Asthma Uk Helpline. The nurses are very good