Hi, so I'm still waiting for formal diagnosis of asthma, or not, and have been advised to chart peak flows for a month then go back to gp.I'm an on brown inhaler morning and night, kelhale, and salbutamol as required although I'm not too sure when to use it .
Anyhow my peak flows after waking are very low, 110 to 150 and I have mucousy cough and slight wheeze, during day I sit between 200 to 300 , predicted is 398.
Should I be taking brown inhaler and doing peak flows before and after ? I've been doing brown and blue as the blue stops my cough and wheeze.
Is it usual to have peak flows a lot lower in morning ? Should I wait an hour or 2 before checking ?
Lots of questions but I've found gp and practice nurse not very good with advise so far.
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51startingtorun
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I take mine before I take my inhalers and about 2 hours after. I enter them on a graph as two seperate lines, if that makes sense.
When I was first diagnosed I was asked to do them 4 times a day, again before and after (with a gap) and enter them on the graph - one line for before and one line after. This was to give the medics a quick view of what was or wasn’t going on.
It is not unusual to have readings on the low side when you first start out. As your meds kick in and you learn what to avoid you should see them rise nicely.
OK thanks, would it take a few weeks for them to pick up ? I've been plotting them on peak flow chart before and after blue inhalers and there is a big difference , it raise by 100 to 150 within 30 minutes . Would I expect to see a difference before and after brown inhalers too , I haven't tlreallt tried this without blue yet
When you first started did you use blue inhaler regularly? I was advised 4 hourly for couple of days then as required . To be honest I'm not sure if that means if peak flow is low or just if I'm breathless and asthma nurse just said do what I think is helping, I was hoping for a bit more of a guideline
I’ve just taken a minute to look up your inhalers as I’m not familiar with them. I think (can other members correct me if I am wrong) the brown inhaler and the kelhale are both steroid inhalers. A steroid inhaler reduces inflammation and swelling in the airways. I was told they take six weeks to have a noticeable effect - some say longer , some say less. The blue inhaler opens/relaxes the airways for up to 4 hours .
Based on my understanding of your inhalers I would expect to see a quick increase in peak flow using your blue as it opens the airways. I wouldn’t expect to see such an immediate effect from the steroid ones - I think this will be gradual over the coming weeks as the inflammation and swelling subsides.
Back to your question. Yes. I took more than the 1 or two puffs every four hours. My meds were different to yours -I was on Fostair 100/6. This contains steroid and a long acting (12 hours) element that opens/ relaxes the airways, but I still needed more of the blue one. Based on that, and the fact you don’t seem to have a long acting bronchodilator I would take the blue as prescribed. If you need more in between I would take it and make a note of it so you have a record to show your nurse.
You do know you can take 10 in the event of an attack?
Just as a side note my peak flow was 100 when I started my journey.
You need to have a chat with the asthma UK nurses on their helpline on 0300 2225800, office hours. They can answer a lot of your questions
They will help you fill in some of the blanks.
The blue inhaler should give you immediate but not long term relief, so in a few months you will normally only take it when you have an issue, but in the short run take it as prescribed, as it will be a while before the brown inhaler does its job.
The brown inhaler will take up to a month or so to become fully effective, but should give you long term relief, and reduce the need for the blue inhaler.
When you go back to GP in a month he will see if your peak flow is up properly and your asthma has settled down, or if he needs to do more.
I kicked off at top peak flow of 250 or so, I am now at 670
As Troilus has said, the brown inhaler can take a while to build up so you probably wouldn't see much of a difference before and after. If it's working you should expect to see your peak flow improving overall and also being less changeable.
A dip in the morning seems to be quite common in asthma, and you want them to see your peak flow at its lowest as well as its highest as the variation is useful information for asthma. So if it's low in the morning, do it then and note the time, and do it end of day and note the time. And keep doing the readings before and after blue too.
As you're not finding your GP or asthma nurse helpful, I'd suggest giving the asthma nurse helpline at ALUK a call a - they can chat through everything and answer your question: 0300 2225800 or WhatsApp on 07999 377 775 Monday-Friday 0915-5pm
You may also find these posts useful - a few years old but still relevant!
Thanks everyone, I think I will go back to using the blue inhaler more regularly as I have been coughing a bit more over last couple of days and feeling very tired
The blue inhaler will open the airways and should help you to cough up any phlegm more easily, but keep an eye on the colour just in case you have picked up an infection.
hi there, you’ve received great advice, I’ve just got a couple of things to add. My consultant isn’t too interested in my predicted peak flow, but is very interested in what is normal for me, how responsive I am to salbutamol (during an exacerbation), and the variability in peak flow during the day.
When I am healthy, I have little difference between morning and evening PF, but when I have an exacerbation, my am PF tends to be lower than pm. Apparently for some people it is the other way around. I recorded PF before my salbutamol and again about 20 mins after, and plot them on a PF graph in two separate colours, like Troilus suggested. In the beginning, I would do this 3 times a day, and the morning one I did shortly after waking. How responsive your PF is to salbutamol helps with the asthma diagnosis.
You can have controlled asthma where your meds mean you have few or no symptoms, or uncontrolled asthma where you need to take salbutamol regularly to relieve cough, wheezing, shortage of breath. At the start of my journey, salbutamol (Salamol) would only provide relief for around an hour before my PF dropped again and I would cough uncontrollably.
I think my consultant said that more than 20% difference in PF readings indicates that your asthma is uncontrolled. From memory, I think that was between am and pm readings under the same conditions (either comparing your ‘before salbutamol’ readings or your ‘after salbutamol’ readings) but I might be wrong there. As others have said, your brown inhaler won’t provide relief from your acute symptoms, so if you took a PF reading before and after the brown inhaler, you probably wouldn’t see a change. The job of the steroid in the brown inhaler is to gradually reduce, then control, the underlying inflammation, hopefully reducing the need for (as much) salbutamol over time.
Good luck with diagnosis and getting everything under control!
Just wanted to say this is a great reply, and also can I have your consultant lol gemwatercolour - those are the measures I find most helpful but my consultant isn't interested in what works for me, only what he thinks should work like FENO!
Completely agree with what you've said, especially re predicted peak flow - 51startingtorun, I meant to say your predicted is just a starting point and an average of others the same age/height/sex. Once you have an idea of your actual personal best (which may be most obvious after your peak flows are more stable), you should always use that for comparison, even if it's different from your predicted.
Thanks Lysistrata! I have found this a great forum for getting quality information and like to help out where I can. Yes, I’m very lucky with my consultant. I was able to find him using private health care and was very lucky to transfer over to his NHS team once the private care ended. He listens, which I find invaluable.
Your brown ive been told takes at least 4 weeks to get jnto your system.As i was put on a new one it was a triple one and got told to persevere with but in the end it didn't suit me and been oub back on my old one and a green one until i see the specailist at hull.
My peak flows varies sometimes they are low in morning and up at night or vice versa.
Its was 400 when started now its 160-200
Over the years it been dropping got even worse since pneumonia in 2019.
Just waiting to ho to hull royal to see the specialist there
If you do before and after i sugest using 2 different colour pens.
If you need any advice or someone to talk to ring the asthma lung uk line up and its 3 you need to press and you'll get to speak to an asthna nurse
When I was waiting for formal diagnosis, I was asked to check my peak flow four times a day, when I first got up, mid morning, mid afternoon and before going to bed, and my scores were always much lower first thing in the morning and last thing at night. Once I got onto the right maintenance inhaler, things evened out much more after a few weeks.
The 'average' peak flow is just that - an average. Your normal peak flow may be higher or lower than your predicted one. Eventually you'll work out what is average for you, which is the important thing. Also, you'll probably work out if peak flow is a good indicator of how you are doing - or not. Mine doesn't have to drop much at all before I feel terrible, but I know other people can be incredibly poorly and still not show much difference in their PF.
The best thing to do would be to call the helpline - they were amazing when I was in the waiting-for-diagnosis and early post-diagnosis stage, and filled in so many gaps that my surgery didn't bother with! Not only did they advise me on a lot of the practicalities (best way of recording PF, how to use inhalers, how to make out an action plan etc) but they also gave great advice on things to ask/say when I spoke to my doctor's surgery.
It can take a while to find the right medication, so don't get discouraged if it takes a while to get things under control, especially if your asthma is seasonal. (I'm much worse in the winter, so we thought everything was sorted the first summer after diagnosis only to find out when we got into winter that it wasn't!) You'll get there in the end!
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