Why is my peak flow dropping & should I be worried?

[Erijenna]

Hi. I'm new here. The average peak flow for my age, height & gender should be around 400. Before lockdown, it was around 350 but has been dropping since an exacerbation in May. This morning, it was at 160. I'm not a smoker, but do have open gas fires, have just bought two air purifiers and exercise regularly, though have been feeling exhausted. I'm on formoterol and formoterol with a steroid. I don't take the steroid one every day because I'm a singer. Any comments about a) why my peak flow is dropping so, and b) more effective medication? And should I be as concerned as I am about my peak flow dropping? And why am I so tired? I have a balanced organic diet and am a vegetarian of forty years.

[twinkly29]

No medication will work properly if it's not taken as prescribed, which for the steroid inhaler is ususally twice a day every day, all the time. Such inhalers prevent asthma symptoms. They take 8 weeks approximately to become fully effective and need consistency. They treat the underlying inflammation caused by asthma. If they're not taken regularly as prescribed there's kind of no point bothering at all. The formoterol only opens the airways - it doesn't actually treat inflammation and is actually potentially dangerous.

So your peak flow is probably really bad because you're not taking your medication properly - tiredness could well be linked too as ongoing uncontrolled asthma can cause that as well. Unfortunately inhaled steroids are the basis of asthma treatment. I know you say you're a singer but if you can't sing because of your lungs/breathing then that's not helpful either.

Inhalers are personal so different ones suit different people. It may not actually affect your voice but if it did there would be others to try

[Erijenna in reply to twinkly29]

Hi...Thanks for taking the time to respond so comprehensively. Regarding your point about the steroid inhaler meant to be taken twice a day, I know that is what most follow; my doctor agreed that I should take formoterol every day and evening and on top of that, formoterol plus steroid twice a week because of being a singer. I teach singers and can immediately hear the damage to the larynx as the steroids weaken the muscles if they are asthmatic themselves - hence, why my doctor suggested twice a week only. (My consultant suggested formoterol plus Singulair tablets as an alternative to the inhaled steroids) I can sing - one learns to budget one's air most effectively and have very strong abdominal muscles ...It's walking that winds me. The thing is, this regimen has worked for YEARS. My peak flow began to drop after an exacerbation in May - I have both asthma and COPD. I have a phone appt on the 23rd and will discuss it with my doctor then. I will certainly consider your response. Thank you.

[Poobah]

Formoterol isn't licensed to be taken as a stand alone medication in some countries as patients started relying on it and didn't take their prevention meds (steroid inhalers) as instructed. The rate of asthma deaths increased, leading to stand alone long acting bronchodilators being withdrawn. And so the combination inhaler was born, containing both steroid and long acting bronchodilator. It's now the backbone of asthma treatment in many countries.

Your decline in peak flow is an indication that your asthma isn't controlled and would be considered in the red zone requiring immediate medical intervention. Many countries have personalised asthma plan recommendations for the day to day management of asthma. The plan will involve your personalised peak flow optimum and what action to take when it declines, including emergency steps when you hit the red zone. The first decline step is usually to increase asthma meds taken daily, but it sounds like you're not even taking your meds as prescribed, hence the worsening peak flow.

Your own asthma doctor is best placed to give you advice in this instance as they know you and your medical history. And I would be requesting a personalised asthma plan. Asthma is a dangerous condition and it can quickly deteriorate. Unless you have a plan of action, you can end up in the emergency room unnecessarily.

You can explore treatments with your doctor and through trial and error arrive at the regime that suits you best. What suits one asthmatic won't necessarily suit someone else, it's very individualistic and in your case, you need to discuss your singing requirements with a specialist. Arriving at your personalised treatment plan will take time but definitely worth it in the long term. In the meantime, seek treatment to get your PF back to normal.

[Erijenna in reply to Poobah]

Hi...Thanks for taking the time to respond. What perplexes me is that this regimen worked for years and was arrived at in consultation with my doctor. My peak flow began to drop after an exacerbation in May - I have both asthma and COPD - and I wonder if it is that. I don't know if the right medication is being given, bearing in mind that I have both conditions and I guess that is what I will discuss with my doctor on the 23rd when I have a phone appt. Perhaps they have come up with another steroid combo that isn't so injurious to the vocal folds..(I can always hear it in other asthmatic singers; it makes it very tricky to sing if the folds don't close properly) I tried one years ago that had been specially formulated for singers and speakers but experienced very adverse side effects. Thank you again and will discuss with doc and post again .

[IChoose]

Well, you're clearly breaking through your medication. Why? I don't know, but it happens. Ensure you have not been infected with covid. That would mess up your asthma badly. Covid causes fatigue but so would the asthma. 160 is very low - I would call doctor ASAP, go to emergency room. Let's hope its a viral infection of some kind and the flair will subside. I emphasize you must be seen because untreated asthma puts stress on your heart. In 2017 after I had been a mess for a while I was diagnosed with possible infarction.