Had an asthma diagnosis for 8 years, recently told I have COPD, and prescribed Spiriva inhaler on top of Fostair. I noticed Boots had an offer on Omron peak flow meters, £14.95 so I got one, and now I'm taking readings morning when I get up and evenings before going to bed. My personal best has been around 390, and I have been seeing readings around 70 to 100 percent of that.
All the guidance on the web says to take the best of three readings, and I had been doing that, but lately curiosity has got the better of me and I have been going further, up to around 5 or 6. I've noticed that the first three might be 300 - 350 - 360, so I note down 360 as usual, but if I go on it's as if I 'get the hang of it' and I can get another three that are 380 - 390 -390. My question is: would it be 'cheating' to use these later, higher figures? Or are they more accurate? Part of me says that everyone is different and maybe the first three are just blowing out the weeds (phlegm etc) if you know what I mean, and of course with any physical activity, you can get in the swing of it and improve within a session. I am ready to be told that the readings don;t really matter and it's the trend that counts.
Grateful for anyone's thoughts on this!
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Sansovino1926
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Hi Sansovino. Sometimes this can happen with me. If my reading is lower than I would expect, I’ll give it another go or two to see if I can blow higher. Likewise if blowing causes a bit of clearance I’ll give it another go to see if clearing the airways has made a difference. At other times, I might find that I can’t get a reliable reading because it sets me coughing, so I just make a note.
For me it is not an exact science. Overtime you will get to know your range and how that fits with how you feel - I can often predict what my reading will be. It is good to know your normal range so you can implement your action plan if you see it sliding or a sudden drop. (It is also a bit useful as a “diagnostic” tool ie having a good think about what you have come into contact with that could have caused the drop.)
In my experience drs are interested in what your peak flow is at the time of the consultation and what it is usually - I was told to keep graphs but I find they just give them a cursory look.
Hi Troilus, thanks for replying. I take your point about these measurements not being an exact science. I think I perhaps have 'measurement obsession'. Today I kept blowing to see how high I could go, and managed to bump up my personal best from 390 to 420 (and the normal level for my height and weight is 530). I also take your point very much that you know how you feel. I am getting attuned to how my chest feels, and ultimately that's as good as a cross on a chart.
How was COPD diagnosed? Was this by an asthma specialist?
The difference between asthma and COPD is that the airflow obstruction of asthma is usually reversible - - that’s why peak flow goes up and down from your normal. COPD is not reversible - it is a progressive disease where airflow obstruction deteriorates ( ( though peak flow can fluctuate). We use SPirometry to decide if the airflow obstruction is ‘fixed’ or reversible and is used therefore to confirm a diagnosis of COPD.
Now the thing many non specialist doctors don’t understand is that Asthma and COPD can co- exist- have a look at the chapter on asthma and COPD overlap in ginasthma.org/reports.
Another thing many doctors don’t know is that asthma , if severe, can result in fixed airflow obstruction and they erroneously diagnose COPD! Someone with severe asthma may benefit from one of the biological drugs used for this.
Also, the most important thing to understand is that asthma is treated with anti-inflammatory drugs ( Fostair includes an inhaled corticosteroid which is one of the antiinflammatory drugs) while COPD is treated with bronchodilators. So it would be dangerous in someone like you to stop the antiinflammatory drug.
So before you accept the diagnosis I suggest you ask to be referred to a specialist asthma doctor in a severe asthma clinic asap. You could justify the request by emphasising 1) that the fact you need three or more types of asthma drug are a risk sign for poor outcomes ( British asthma ) guideline; and 2) the fact that combined asthma and COPD is a risk factor for poor asthma outcome and 3) that 29 people died in the UK National review of asthma deaths ( NRAD 2014, Royal College of Physicians) because their severe asthma was incorrectly treated as if they had COPD.
Hi, Africanleopard. Thanks for answering. Here's my story in brief:
In September 2023 I was told I had COPD in a letter following a chest scan offered to me by my NHS region because I was a smoker aged over 55. The results letter also mentioned sodium deposits in blood vessels around heart. In 2018 I was diagnosed with asthma by a GP and spirometry suggested asthma rather than COPD, and put on Fostair preventer and Salbutamol preventer. In 2021 The Salbutamol was replaced with Fostair used as MART therapy.
I gave up smoking on 30 September 2023 and have not smoked since. The effects were quick to appear & are continuing. Astonishing, life-changing improvements to breathing, stamina, appetite, smell, taste, mood, etc. Hardly ever cough. Still a bit susceptible to pollen. Nothing much happened after the scan until July 2024. I was asked to attend meds review at GP surgery, told 'as you have COPD' that Spiriva Respimat was indicated, as an additional medication. Also advised to use a small ('Easychamber') spacer device. For the avoidance of doubt, nobody has suggested that I give up my Fostair MART therapy.
Nobody told me to get a peak flow meter, or keep a record. I wonder if my gently rising PEF readings might be as much to do with improving technique as any other reason.
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