inducing asthma by doing Peak Flow

Just wondered if I am the only one with this problem. I have brittle asthma and if I am well I can do a Peak Flow and I become a bit wheezy. If I do the standard 3 Peak Flows then I have a full attack and need a nebulizer. Needless to say, I dont record my Peak flow much as it makes me ill. When I go to see my consultant I can be really well. I do my lung function tests and then afterwards my chest is rubbish! I was in hospital with a bad attack a week ago and a doctor wanted me to do my Peak flow in recus whilst I couldnt speak, my gases were rubbish, I was on Aminophylline and Magnesium. I refused to do it because I knew it would make me much worse than I already was and they had a go at me for refusing to try a peak flow. I am starting to think that I am the only one who has this problem. The medical staff certainly dont understand and argued with me for the whole time I was in hospital. They wanted my chest to be better, yet everytime they pressured me into doing a Peak flow my chest got worse and took several nebs to recover. Eventually I told them I was not going to do anymore Peak flows as it was making me worse but they werent impressed. They said that nobody else seemed to have a problem with doing peak flow except me! I really cant believe that I am the only person who has experienced this. Any advice would be great.

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Hi Karly,

I get this and I know plenty of other asthmatics that do as well - in fact I would say that if you have severe asthma and are doing peak flows properly it is almost a universal experience! In the same way, I also find that sneezing will provoke bronchospasm, and I have seen patients produce bronchospasm by hyperventilating - if your airways are in the least bit twitchy moving air through them rapidly will irritate them.

Even my mum, who is a newly diagnosed mild asthmatic (oh yes, you are, mum, whether you like it or not!) finds that her first of three peak flows is always the best one - after that she gets some bronchospasm and her PF drops.

Having said that, if you do experience this, it is probably a sign that your airways are overly twitchy and your asthma is not as well controlled as it could be. Obviously, Karly, with a diagnosis of brittle asthma and recent hospital admissions you are probably well aware that you fit into that catagory, but for the benefit of other asthmatics who may not be on mmaximum treatment, I would say that if your airways are twitchy enough to experience this phenomenon then it is probably worth mentioning it to your doctor or asthma nurse to see if they feel that a change in medication might help.

Personally, I don't tend to really do peak flows at home as they do make me worse (and they are not that useful as I go off so quickly that they are not predictive of an attack) - when I am in hospital, if they really want me to do peak flows I will compromise and do one, rather than the usual best of three (as I say, the first one is always the best anyway). I have previously discussed this with my consultant in out-patients and he is understanding of the problem and agrees to this strategy. Spirometry always makes me bad too, and I will try to do it the bare minimum of times - most of the time if you explain to the technician that it does make you worse they will try and minimise the number of times you have to do it and will often let you do most of the readings as gentle blows out rather than the forced exhalation they normally make you do (they do have to do that for some of the readings, but a lot of info can be got with just gentle blows).

I certainly agree that they should not be trying to force you to do a peak flow during an acute attack - apart from anything else, if you already have several markers of a severe attack, which it sounds like you probably did, knowing that your PF is <50% or <33% does not particularly add much more useful info. I have very rarely been asked to do a PF in an acute attack, and I certainly would not ask a patient to do one if they were unable to talk, etc. I think you did the right thing refusing, if you were not comfortable with it.

I would suggest you talk to your consultant in out-patients when you are not in the middle of an acute attack/admission, and explain the problem, and see if he will document in your notes that you need not do peak flows frequently, or only need do one on each occasion.

Hope this helps

Em H

[KateMoss]

I don't do PFs on a daily basis because I I tried 3 in a row I get tight too!

Though I do try to check if going down hill. One is enough and often I go furhter down hill after!

My Consultant is happy with me not doing them because I can judge my asthma better by the symptons than PFs.

Karly, get it written onto your protocol that doing PFs makes you worse.

I have a note not to do ABGs unless sats below 90% - works most of the time.

Take care

Kate

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I get a similar phenomenon when chest not good...each reading gets lower and lower! (The meter must be laughing at me as I type this!)

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I do twice daily (technically) pre nebuliser PF's I have a PIKO which gives a FEV1 too and by the time I have done my first as rule I have induced a bronchospasm and need to neb. If I did a post one I would just set the whole thing off again and need to do another neb and I would get into a silly vicious circle. When I have been under assessment at the RBH I have done them more than twice a day. Now however we are looking at trends I don't need a blow into a meter to know when I am getting into trouble. Interestingly my FEV1 is a far better indicator of trends. I use that to tweek my medication as it does give me early warning things are not going OK long before a PF used to and I do find that a tweek in medication at the right time will bring the old FEV1 back up a bit giving me more quality time at home with the kids.

Bex

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Me too

Andrea xxxxx

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Thanks for all the replies. I am seeing my consultant on Monday so will ask him about it. I tend not to do Peak flows at home as my chest goes downhill so fast that they rarely give me any advance warning anyway.