I had lung function tests yesterday as a result of which I was diagnosed with asthma and started on a Fostair 100/6 inhaler. I return in a week for monitoring.
When I had a FeNo test 18 months ago I scored 36. Yesterday I got 192, 167 and 150.
This seems very high and I wonder what it indicates. I also wonder how long it will take for the inhaler to make a difference.
I had these done last week the consultant said score should be 40 and under ,mine was 130, Im on Fostair 200/6, spiriva, montelukast, and still blowing a bad score so being referred for injections to stabilise things .The test measures how much inflammation is present .
Thanks Nanto4. I hope you improve. May I ask what the injections would be?
FeNO measures a specific type of inflammation in your airways that many people - but not all - can have with asthma. It can be useful to get an idea of whether you have that inflammation, because it doesn't always show symptoms but needs treatment as it is dangerous to have uncontrolled inflammation even without symptoms of asthma.
Some doctors like to use FeNO for routine monitoring but that's not always ideal, because while that can be helpful for some people, it doesn't work for everyone even if they have that type of inflammation.
But as your numbers are high it will be helpful to measure how the inhaler affects it. There are different cutoffs - I've usually had: over 50 is high and over 25 is intermediate. Yours are definitely pretty high! Ideally the inhaler will reduce the inflammation and bring those numbers down to under 50 or lower.
The inhaler can take up to 6-8 weeks to work fully though so don't be discouraged if you're not seeing a big drop in a week - it might take a bit of time and people are different.
Thanks, Lysistrata. That’s really helpful to know it’s not an immediate rapid improvement. The spirometry showed some obstruction which might indicate COPD (I am a never smoker) but the excellent consultant thought the very high inflammation levels might well be causing this. I was a bit shocked because, as I said, 18 months ago my spirometry was normal. A chest CT scan with contrast two months ago was completely normal.
Obstruction can also happen with asthma! But a lot of machines and online calculators will just flag it as query COPD for some reason if you have obstruction (this is just when the amount you can exhale in the first second (FEV1) is less than a certain amount below the total amount you can exhale (forced vital capacity, or FVC).) Or some even flag as COPD if you just have a reduced FEV1, which can be due to all sorts of things. Spirometry is more complex than machines and even some human medics make it, but sounds like your consultant is on the ball and reading it in context.
It's not impossible to have COPD as a never smoker (around 20% of those with it have never smoked), but the other factors would seem to make asthma more likely. And asthma is variable, so even with severe asthma you can have perfect spirometry one day and obstruction the next.
I’m really grateful for your responses Lysistra as I’m so new to all this and it’s a bit scary.
I was very impressed by my consultant. My situation is probably multi-factorial as I also have Laryngopharyngeal Reflux and Anxiety (and maybe some chest wall dysfunction) and she explained how these interlock.
What I don’t understand is that my peak flow for my age and height is 520 which I was consistently achieving on my home spirometer. In the last few weeks it was falling to 450 before the inhaler but it goes back over 500 afterwards. I presume the high inflammatory marker is responsible for the drop but it does still seem reversible.
I'm glad it's helpful and you seem to have a good consultant! I think a lot of people have other things going on which definitely does make it more complicated to work out.
This post might help you with peak flow: healthunlocked.com/asthmauk...
What you've said about peak flow definitely makes sense for asthma - reversing after your reliever is classic for asthma. It does sound like something has been affecting your asthma, which for you is also shown by the high levels of inflammation in your airways (asthma has complex biology so a range of things can lead to the end result of your airways narrowing). Ideally the inhaler will reduce the inflammation over the next few weeks and then your peak flow should stay high and not change much; at that point, if you're controlled, you shouldn't need to use your reliever inhaler more than 2-3x a week at most. Though to be confusing, symptoms and inflammation are linked but not the same in asthma, so you can have symptoms (which are asthma, not mimics) without much inflammation and inflammation without much in the way of symptoms.
Because you said you're new to all this, I'm also going to share these posts which may help:
This is basically a practical introduction to asthma: healthunlocked.com/asthmauk... (bear in mind it is 3 years old so was written when access to face to face appointments was limited).
And this one is a guide on what to do when with asthma: When do I...?: healthunlocked.com/asthmauk...
It took a couple of months before I settled properly with fostair 100.
I use a spacer which helps a lot. I also found an asthma nurse who helped improve my inhaler technique which again helped.
It is very useful to ensure you have access to an asthma nurse as well as a doctor. The asthma nurses tend to be more practical and have better availability. If you do not have it already ask for it.
The asthma UK helpline is very good.
Thanks, Homely2. That helps me to be realistic about how long it takes to stabilize. I’ve only just been diagnosed but NHS healthcare is 5 stars where I am.
About 2 months for the Fostair to really work for me.
In fact my peak flow meter had been bumping along at about 180/200 for some time before this. After about 2 months with the Fostair, one day the meter abruptly jumped up to 300 and it's been fluctuating between 290 and 360 since then.
I would say that the Fostair has transformed me to be honest. I am still quite sensitive to various triggers though - mowed grass, dust, pollen, beer and wine etc.
Thanks, Don_Alejandro. That helps me to have a better idea what to expect. My best peak flow is about 520 but has been dropping to 450 in the last few weeks before I use the Fostair inhaler. It seems according to the FeNo test that my inflammation in the airways has run riot.
I'm not really sure why my peak flow scores were so low - and relatively speaking still are. Maybe my height? I'm about 5'3" - on the small side for a man.
I hope things work out for you. Persist with the Fostair if you can, my asthma nurse urged me to continue when I expressed doubts at about 2 or 3 weeks.
Fostair - New Inhaler
High FeNO levels
Feelings about FeNo testing 
Significant reduction in Ventolin inhaler use after Astra Zenica Covid vaccination. 
