Asthma UK community forum

Very low early morning peak flows


I am still struggling with this reduction in steroid thing. Been down at 30mg for around a week now but every morning I have dreadful trouble awaking 4:30am - 5am with PF of 50 to 80 when my best is 450 to 500 (evening only). 2 x nebs and I usually pop back up, with once being an a & e visit and some IV hydroquartozone given on arrival with more nebs. Has any one researched or is there a clinical reason as to exactly why these pf's dip so dramatically early morning. With it I have the Shortness of Breath, resp rate increased & of course heart rate increased all until nebs kick in. I would love to know if this is something to do with the way I breath when I sleep, or perhaps a trigger in my room. I have bought new pillows, damp dusted again and run a dehumidifier/ionizer in my room. Has my adrenal gland given up working? is it a hormone 'dump'? Is it the way my lungs work when I sleep? I have googled a few sites but surely there is something more I can do. Consultant has asked me to stay on 30mg pred & usual maintenance stuff and daily nebs for another few weeks till I see consultant again.

Any suggestions or a point to a good website for research would be so so so welcomed.


3 Replies

hi there,

because of the way that cortisol, the steroid your body produces, is controlled, it is released in the early morning. (diurnal variation, and circadian rhythms etc). Asthmatics are recognised to have overnight/early morning dips in pf because of this - it is a sign of poorly controlled asthma and not likely to be something you are doing wrong. Apparently everyone has narrower airways at this time of night, just that only asthmatics get enough of a change to notice. Sometimes I have seen the chest folk give the steroid dose split slightly, so that most is taken in the morning but some, say 10mg, at teatime, to attempt to prevent the night time dip. If it is taken later than teatime it will keep you awake though. It might be worth speaking to your GP about trying that, or your cons if you can ask sooner than your appt in a few weeks. I can't think of any references to these problems off the top of my head - it is something that is not new so not likely research papers around on it but if you can find an online medical textbook it would probably explain it better.


Thank you so much, I will have a chat to the consultant about dosages and the times I take the meds - a good idea. The disparity between my AM and PM peak flows is so great and the morning is really tough till the nebs work and of course always an early morning start annoying both my kids and husband. If I drop pred down it is an a & e visit with IV hydroquarterzone (sp?!) and more nebs. Just can't get the pred down at the moment.

Thank you again - it is encouraging/helpful to see it is a common problem and not just me. I will do some further research and see if I can google a text book or two.



i recently changed 2 splitting my pred now taking it half n half i was waking bout 4 to 5 times in the nite needing a neb. its sort of worked but thats probably cause i cant sleep!!! used 2 get about nine hours sleep now down 2 5 at the most grrrrrr lol! its helped but its probably cause im not sleeping enough! dosnt take as long 2 recover in the morning as i used 2 but again i think thats cause im not sleeping as much! not bin of much help sorry! x


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