Had my first ever lunch function test done this evening.
FeNo was fine at 13.
Kind of frustrating as I was told to continue using my inhalers when I checked yet turns out I should have stopped them.
she initially said lung function was good and then said it was on the low side.
As I had taken my inhalers this morning she wasn't going to do reversibility and then decided why not yet reversibility was only 13.5%.
My follow up phone call with respiratory nurse is only in January so now left really confused and annoyed I was told to continue meds when I was meant to stop them.
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Oh that's so annoying! I don't know why they so often do this...it's really not hard to give the proper instructions! Grrr. I know it's only your first and you were doing what you were told as no reason to believe they were wrong, but in future you will probably need to double-check everything you're told before these tests (can always ask AUK nurses if you're unsure).
If you look at it one way though, the usual cutoff for reversibility in asthma is either 12% or 15% (varies in different guidelines) and you were either over it or nearly there WITH your inhalers, so I bet you would have been over without them! If you're told no evidence of reversibility, tests don't show asthma etc by anyone, make sure to point this out. Do you have any other numbers? Again it doesn't mean a huge amount if you were on meds, other than to show how you were on that day with current treatment, but may be useful to point out if anything was a bit low or close to a cutoff, if you can say 'yeah but I was still on meds'.
Re the FeNO...on meds that likely just shows you're taking inhaled steroids and they're doing something. Not hugely useful by itself; if you were symptomatic on the day it doesn't mean that isn't asthma-related, just that they didn't pick up inflammation so for example giving you pred might not be much good.
I hope this helps...I don't really have much useful to add other than, aghhh and again why can they not give simple instructions properly! I would say can you get in touch and flag this but don't know if you have a contact for the dept? Can you contact the asthma nurses outside specified appointments (eg if you were having a flare)? If so maybe tell them? But equally don't know if it will do that much.
Thank you for your reply, it does help and makes me feel a bit better that I was either over or nearly there on reversibility on meds.
Just annoying as I did call to double check and was told if letter doesn't say to stop meds then don't stop taking inhalers.
I don't have any other numbers, the last go left me seeing stars and clutching my head for about 5 minutes to try and stop the shooting pains.
There was loads of numbers on the screen yet being my first time I wasn't sure what I was looking at and what meant what.
I do have a number for the respiratory nurse and she did say I could phone at any time if I had any questions so I might give it a day or so and then call to ask.
I think its more the "so do I have asthma or not" .... I've spent the past 2 and a bit years thinking I have asthma and I've had 4 admissions in the last 12 months so for them now to be questioning it just confuses me.
Thanks again for your reply it has made me feel better 😊
I'm glad it helped! I totally get where you're coming from as I am a massive unicorn asthmawise🦄🦄. This basically means they often question the asthma or do the 'I know you have asthma but this isn't asthma' when it just isn't typical/textbook. Although asthma is known to be variable, this often doesn't seem to translate into recognition that you can be very up and down even within a day.
Sounds like a major communication fail there...the NHS has many wonderful features but communication is frequently not its strong point.
If you do have a number for the nurse and they're happy for you to get in touch then I would say definitely worth it, even if they don't do anything in particular -then they can at least make a note/register what happened.
Agree with Lysistrata but wanted to add that, hopefully, the nurses will take the on meds thing into account. My nurse team do with feno as with mine they say yes that's what we would expect right now.
I was interested to see you mentioning FeNo. I took part in some kind of survey or feedback on FeNo last week. I assumed that FeNo was some new thing that isn't being generally used yet.
What is your experience of FeNo ? Is the score a reliable indicator of how your asthma is ?
It was the first time I've ever had it done so not sure if I'm a reliable source on if its a reliable indicator. My asthma feels controlled at the moment and I'm on inhalers that should reduce inflammation in my lungs so the fact that I got a normal score I would think is normal and shows my asthma is well controlled at the moment.
FeNos been about for years. My local clinic usually do it every outpatient and every admitted patien (or they did prev COVID).
It only shows indicates whether steroids will work for you. Not every asthmatic responds to steroids, so it does nothing for them.
Eventually I’ll do a post about feno/NiOx but from experience it doesn’t represent symptoms - I often find my number goes up after an attack (2-3 days in to an admission). I’ve scored 194 (I think) the day before discharge from hospital and feeling good, and have scored 120ish before an admission from clinic feeling terrible. I’ve been 55 whilst being symptom free and 43ish when I’d had moderate issue. The lowest I’ve scored is 18.
I really don’t want feno to be introduced as a GP level diagnostic tool (something that’s currently being debated) as I really doubt they’ll understand the complexity of it, and apply them. I suspect people who score low will just be told they ‘don’t have asthma’, rather than ‘when you did that test you didn’t show signs of needing steroids’...
At some point I need to do a post about this 😅😂🙈 but until then there is a little bit about it here (near the bottom if you don’t want to read it all 😂); healthunlocked.com/asthmauk...
Thank you for your comments and for your the link to your previous comments.
I have had asthma for over 50 years, but I'm learning all the time about it. It would be good to have a post on diagnostic tools. I can think of FeNo, peak flow meters and spirometry. No doubt there are others. What are your views on which of these tools are most helpful with asthma ? For example, I find peak flow meters to be as useful as you find FeNo. When my asthma is terrible and I have a chest infection it will be 450. When my chest feels fine it will be 300.
Also did you link the use of steroids to inflammatory asthma ? I have never heard of inflammatory asthma. Do we need to know if our asthma is inflammatory or not ? Are steroids only relevant in the treatment of inflammatory asthma ? I'm a big fan of Pred.
PF is only really relevant if your asthma affects larger airways. FENO if you have Th2-inflammation. Spiro if you are symptomatic at the time. Histamine/mannitol can induce asthma to show symptomatic spiro. Oscillometry is new and a lot of the people using aren’t 100% sure how to apply it yet (some theory that it may be better than spiro, but again only really when symptomatic, and they don’t have a large enough sample to really say what normal yet like they do for PF etc)
The majority of asthmatics are Th2- inflammatory. This covers allergic and eosinophilic driven asthma. They are the ones who find pred a life saver.
The smaller subsection of non-eosinophilic, non-allergic asthmatics however usually don’t have this inflammatory marker and this don’t really respond to steroids. (I’ve spoken about this in my steroids post).
Collectively there is a group of us planning on covering the asthma phenotypes (ie allergic, eos etc etc), as well as tests of various types 😅. (We have a list of 17 topics we still need/want to cover 🙈)
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I totally get where you're coming from as I am a massive unicorn asthmawise🦄🦄. This basically means they often question the asthma or do the 'I know you have asthma but this isn't asthma' when it just isn't typical/textbook. Although asthma is known to be variable, this often doesn't seem to translate into recognition that you can be very up and down even within a day.
Broncholidator Reversibility Test
Doing lung function tests
FeNO result of 39
Baseline figure from lung function test
