High PEF even though close to seeking emergency help.

[CotswoldSquirrel]

Hiya,

I have a high PEF, normally around 620. This week, I had a bad flare up and almost got to the point of calling an ambulance. .

Even during the attack, my PEF didn't drop below 600.

I normally take Fostair 200/6 two puffs morning and 2 puffs evening and Montelukast

I called my gp and spoke to the nurse who prescribed prednisolone (40g). I'm now recovering slowly but it seems I can't trust my PEF readings to warn of an attack.

Everything I've read says that PEF will drop, is this always the case or are there some people who just have a steady PEF?

I'm worried that if I did need emergency help that I might be brushed off because of high readings.

Many thanks, Jess.

[Carriejen]

I cant really offer much in the way of advice, but from my own experience when my asthma flares my PEF doesn't really tend to drop any lower than 400. My best is 500, but at the moment my average is about 470. I personally dont think peak flow is a good indicator of asthma problems, mines has only dropped a couple of times when I've had a really bad chest infection. I had a (non medical professional, fellow asthnatic) woman on a fb group tell me a few months ago when I asked this same question, that I likely didn't have asthma and to not take my blue inhaler next time I felt I needed it! She advised just to take deep breaths... some people eh? Hope you're on the mend now 😃

[CotswoldSquirrel in reply to Carriejen]

Thanks Carriejen, it's reassuring to hear it's not just me.

I still use record my PEF but I am going to stop relying on it as a 'when to call for help' warning and go purely by my symptoms. I think I probably should have called an ambulance last week but didn't because PEF was still in the average range.

Today, I am finally starting to feel like I'm recovering.

[Carriejen in reply to CotswoldSquirrel]

I also don't tend to wheeze so I have a lot of issue with the hospital. Thankfully I haven't needed them in around a year! Going by how you feel is likely a much better indicator for you personally. Dont feel bad or refuse to seek help because you think you're OK 😃

[CotswoldSquirrel in reply to Carriejen]

Thanks. I think I just need to remember to stop being stubborn and independent 🙈🤣

I'm going to pack a hospital bag to keep under my bed so I have one less excuse!

[MMBJI]

Hey, my peak flow does not reflect my state. I can feel ok but blow under 300, and be in A and E (because of an attack) and blow over 400. It makes no sense to me.

However, I have recently seen a Respiratory Physiotherapist who thinks that I am breathing incorrectly. This could explain the incongruous PEF readings, ie; what I have perceived as asthma attacks aren’t always that, but partly my breathing technique.

I am not convinced, I now feel confused about how to differentiate between my asthma and just over breathing.

All that said, it’s always better to be safe than sorry, especially when dealing with asthma. If you feel like you are struggling enough to need extra help then it is time to go to A and E.

I avoid going unless I really have to, and go prepared for some “discussion “ around whether it is really asthma or not. It’s usually ok. (It can be helpful to take a written account of what’s been going on, when talking is too hard!)

[CotswoldSquirrel in reply to MMBJI]

Thanks MMBJI. I've been practising some breathing techniques to help if I'm doubting. They did help yesterday but not during the bigger attack last week so I'll probably use those to help me decide how bad things are.

[EmmaF91 Community Ambassador]

For some people PF really does reflect the state of their asthma, however for others it can mean absolutely nothing. There is some thought that this is because PF measures large airway construction, but for some people the issues can start in the smaller airways. However, lots of doctors are unaware of this so may give you issue if your PF is ‘too good’. That being said there are also docs who insist that asthma is wheeze and no wheeze means no asthma so... they basically don’t understand asthma anyway 😅

If you haven’t done it already it may be worth asking the GP to refer you for a LFT/spirometry test to officially confirm asthma, as that can then give you more confidence in yourself that it is asthma. Spiro/LFT/oscillometry (which is much newer and not too much reference available yet) can also assess the smaller airways.

I suspect that a lot of people who have PFs that don’t drop have actually ‘trained’ themselves that way by singing or playing wind/brass instruments professionally etc, but I may be wrong 😅 (they also tend to be the ones with a much high PF than predicted)

The other things you may want to read is this for more info on PF in general; healthunlocked.com/asthmauk...

And this, to help you know how to spot a couple of common mimicers (and know how to ‘prove’ you don’t have them if you get told it IS that with no evidence); healthunlocked.com/asthmauk...

Hope this helps and that you’re feeling better now

[CotswoldSquirrel in reply to EmmaF91]

Thank you, I've played woodwind (recorder and then flute) since I was 4. So that explains the high PEF. Maybe my indicator on how well I'm doing is whether I feel like I'm going to faint after hitting 620 or not 🤣🙈

Thanks for the info, I'll have a read through in a bit.

[EmmaF91 Community Ambassador in reply to CotswoldSquirrel]

Yup. You’ll have to focus if your symptoms as to when to seek help. And issues like feeling faint after PF may help indicate problems for you.

I’m lucky that I have a reliable PF as I don’t feel symptoms (despite other people hearing issues in me) until it’s too late and I’m needing hospital 😅. I have an epic best PF tho and that’s due to a king history of sport.

[Smoggy1990Boggy in reply to EmmaF91]

I have never heard of oscillometry? How long has that been out?

[EmmaF91 Community Ambassador in reply to Smoggy1990Boggy]

Really not that long at all 😅. I’ve only heard of it being used in specialist hospitals and most people who have done it have actually been told that they aren’t 100% sure how to compare to others/translate scores yet as the don’t really have a ‘base average’ and is only really helpful to compare against yourself (like with spiro/peak flow).

But it’s apparently a way of measuring small airway issues tho I think (as you can tell from the hedging I haven’t actually done it myself 😅😂)

[Bella-Bestia]

Hi, when I was having a difficult time a few months ago a respiratory nurse from the hospital called. She had access to my spirometry results, so when I was talking about my PF not dropping much she said that I was not to concentrate only on that, as “I have a good lung volume “but to be aware of other ways that I was feeling my asthma flare up.

For me my main symptom is tightness in my chest.

I would suggest that, although PF is a useful indicator, it doesn’t always reflect the whole picture.

From your comments I am guessing you felt that you were having a flare up but maybe doubting yourself because of your PF reading?

It’s important that you take care of yourself.

The hospital/ emergency services would not have a problem with seeing you.

I once had a trip to A&E after calling out of hours as they said that I needed to go there. I just felt that I needed to get the help from a GP. This was when I hadn’t yet been diagnosed.

I kept apologising at A&E but they said that I was in the correct place. Two nebulisers later I got home feeling much better, followed up by a GP appointment the next day.

I hope this helps.

Take care,

Bella-Bestia

[CotswoldSquirrel in reply to Bella-Bestia]

Thank you, that's really helpful. My main symptom is also a tight chest and a dry, tight cough.

[Jimmy-Lyden]

This may seem obvious but have you changed your device? A while ago I was given a new one as I'd misplaced my regular one. It was great, I was hitting 430+ whereas usually I would hit 310 on a really good day. As per usual, I found my regular one a couple of days later and it showed 300, my usual. I kept using this one and reported the anomaly to my GP... who then thought I may have a problem using the device and checked my technique. He then agreed there may be a problem with the replacement. Either way, good luck!

[CotswoldSquirrel in reply to Jimmy-Lyden]

Thanks, that's a good thought. It's the same device so I think I might just be odd.

Thankfully the GP has re prescribed my summer prescription of fexofenadine and that seems to be helping. So hopefully it won't be long till I'm back to normal.

[Jimmy-Lyden]

Excellent! That's good. With my new device there was a tiny bit of plastic behind the bit that moves, so in order to move it there was a minute build up of pressure which when released blew the bit further than it should have gone. I suppose I was going down the wrong road if you're getting the same reading at the GP than your getting at home.. sorry about that. As we're all finding out during this Pandemic, asthma isn't as, relatively, straightforward as we thought it was. Keep safe & all the best.

[CotswoldSquirrel in reply to Jimmy-Lyden]

It was a very good thought. I'm glad you shared.