Peak Flow

As it seems to be peak flow day here, thought I would ask some advice too.

My peakflow was between 250-300 when having difficulties. After treatment it is now generally 280 -300, 320 on a rare occasion. I don't have any of the symptoms at the moment so should I worry about the peak flow still being low. Apparently it should be about 420 for my age.

Yvonne

5 Replies

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  • Hi Yvonne,

    Have you had your peak flow technique checked by your GP or asthma nurse? Poor technique can make your readings dramatically lower than they should be, and makes peak flow a less useful tool in monitoring your asthma control.

    If your technique is good, your peak flow is stable without undue variation between morning and evening, you are well, and you are not limited in physical exertion or using lots of salbutamol, then it may just be that that level of peak flow is normal for you. The normogram does state that women can have a peak flow of upto 85 below the predicted value given and still be normal, but some people do have readings even lower than that. That's why it is important to know what your individual best reading is and to change your asthma management based on that, rather than what your predicted reading should be, if possible.

    Of course, if you do have symptoms, limitations on the amount you can do, big dips in the morning or are using lots of salbutamol then your low peak flow could be indicative of poor control and you should go to your doctor to see if you need more treatment!

    Hope this helps,

    Em H

  • Thank you Emily H,

    I understand what you are saying. I feel quite well at the moment as regards the asthma anyway - the rest of me is falling apart however, but heh that's life.

    (PS do you do private consultations?)

    I had lots of problems when my peak flow dropped to 250 - 270, which really is not much lower than my best of 300. Maybe because the best peak flow is on the low side the degree of differential has more impact. Does that make sense?

    Also my GP referred to my asthma as allergic COPD. As I was feeling quite unwell at the time I didn't have the energy or the breath to question him further. Could you explain what he meant by this, or is it just another term for asthma?

    Many thanks for your replies

    Yvonne

  • Hi Poggins one reason for your best peak flow being so close to your worst is over a long period of time some people with respiratory disease their bodies become adjusted to either less oxygen or air flow. Some cons actually dont worry and say you can live normally as your body comepsates and becomes used to it just the same as people live happily with one lung or kidney for example.

    If you have concerns you should air them with your GP or ask for a referral to a respiratory cons.

    Your question about COPD is now used a an umbrella term to describe respiratory disease.

    The British Lung Foundation has this information on its website:

    What is COPD?

    COPD stands for Chronic Obstructive Pulmonary Disease. This is a term used for a number of conditions; including chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lungs. The word ‘chronic’ means that the problem is long-term.

    [TOP]

    Some Definitions

    Chronic bronchitis: bronchitis means 'inflammation of the bronchi'. These are the tubes or airways which carry oxygen from the air through the lungs. This inflammation increases mucus production in the airways, producing phlegm which makes you cough.

    Emphysema: this is where the alveoli (air sacs) in the lungs lose their elasticity. This reduces the support of the airways, causing them to narrow. It may, if severe, lead to people having difficulty absorbing enough oxygen. This can result in shortness of breath.

    [TOP]

    What causes COPD?

    The most common cause of COPD is smoking. Once you give up smoking, you gradually reduce the chances of getting COPD - and you slow down its progress if you already have it.

    Occupational factors, such as coal dust, and some inherited problems can also cause COPD. Whether pollution is a factor is under investigation.

    [TOP]

    How is COPD diagnosed?

    Cough, phlegm and shortness of breath can be symptoms of COPD. Some people may only notice their symptoms in winter, or they might put them down to bronchitis or ‘smoker’s cough’. This means that they might not seek help at an early stage of the disease. The sooner people seek treatment the better.

    The best way to confirm diagnosis is through spirometry. This is a simple breathing test which you can usually do at your GP’s surgery. You just have to blow into a machine. This will indicate whether your airways have narrowed. In some cases you may need more detailed tests and a referral to hospital.

    [TOP]

    How do people feel?

    The symptoms of COPD vary depending on how bad it is, and how people have adapted to their problems. In mild cases, symptoms like a cough, phlegm and shortness of breath may only be present during the winter or after a cold. In more severe cases, you may be short of breath every day. With more severe COPD, normal activities can become more difficult.

    COPD can lead to feelings of anxiety because of breathlessness. People with it may reduce their activities to avoid becoming breathless. But by reducing activity levels you become less fit and therefore get breathless even sooner when you try to do any activity. People with COPD may adapt their lifestyles to reduce breathlessness - but keeping as fit as possible is important.

    Some hospitals run pulmonary rehabilitation courses. These programmes involve exercise and education. Pulmonary rehabilitation improves your exercise performance, your health and your quality of life. Your doctor/nurse can tell you more.

    Care and support from family and friends can do a lot to relieve anxiety and depression. The BLF’s Breathe Easy support network offers information and advice to people with COPD and other lung conditions. For more details, contact Breathe Easy at the address below.

    [TOP]

    Can we prevent COPD?

    COPD cannot be cured once you have it, but treatments may help. For most people, stopping smoking reduces the risk of developing COPD and also slows down its progression. However, some people develop COPD for other reasons which may be more difficult to prevent.

    [TOP]

    Treatment

    There is no cure for COPD but a lot can be done to relieve its symptoms. Stopping smoking will help improve the cough and phlegm. It’s likely that you will be given medicines - usually by inhalers - that make the airways wider. These are known as bronchodilators. If your main symptom is breathlessness, then you may benefit from a bronchodilator. There are different types of bronchodilators which work in different ways and they can be of benefit if they are used together. You may also be prescribed other medications. Nebulisers can provide bigger doses of the medicines but inhalers are often effective. What you are given depends on how you respond to treatment.

    If you become suddenly more short of breath and your symptoms get worse, you may be experiencing what is known as an ‘exacerbation’. Your doctor may give you a short course of steroids for a few days. Some people take a steroid inhaler regularly but your doctor will decide if this is necessary for you.

    Exacerbations are common in COPD, but taking your treatment regularly may help to reduce how often they happen. Always seek treatment for any exacerbation as soon as you can. A flu vaccination every autumn is also worthwhile, as flu can cause exacerbations.

    Try to keep as mobile as you can, look after your weight and eat a balanced diet.

    [TOP]

    What about oxygen?

    Some people with COPD develop low blood oxygen levels. The long-term use of oxygen at home can be beneficial for some people.

    To find out if oxygen can help you, see your doctor who will arrange for tests in the hospital out-patient department. You will have your blood oxygen measured. If necessary you will be prescribed oxygen at home using an oxygen concentrator. This is an electrically operated machine that takes oxygen from the air in your home. You can breathe the oxygen in through nasal ‘cannulae’ (small, soft plastic tubes that fit just inside your nostril) or a mask. The oxygen supply tube from the concentrator may be many feet long, so you can move around the house whilst having your oxygen treatment.

    Some people are given portable oxygen as well as their concentrator. Various small oxygen cylinders are available, which your doctor can prescribe. They can last for several hours and make shopping or travelling easier. Lighter cylinders are also available but currently can only be purchased from a commercial supplier.

    Please note that the rules for prescribing oxygen are due to change in 2005 and an updated version of this leaflet will be available when the changes are made.

    You may also need oxygen for travel – ask your doctor for details. The BLF produces a booklet on travelling with a lung condition, which can be obtained on request.

    Last updated: July 2005

    Related publications:

    COPD – diagnosis and treatment (booklet)

    COPD – living with Chronic Obstructive Pulmonary Disease

    Going on Holiday with a Lung Condition (booklet)

    Pulmonary Rehabilitation (leaflet)

  • Hi Bowmei,

    Thank you for your in-depth reply.

    When I was a child and into my teens I suffered from severe hayfever, to the point where I spent most of the summer indoors. I then appeared to outgrow this and developed asthma when I was about 21. It never bothered me to any great extent and I only used a reliever inhaler rarely. I did have a couple of acute episodes, where in retrospect I probably should have called an ambulance.

    Over the years I had noticed that I had become progressively breathless especially on exercise or going upstairs, but did not really relate this to asthma. I just thought I was unfit. My nurse did want to treat it but the GP did not seem to think it was necessary. I think it has probably crept up on me insidiously until recently went I became quite ill. I think this would probably fit in with your explanation of a low peak flow rate.

    I do not wheeze with asthma. I get very breathless, cough a lot, and feel as though a Sumo wrestler is sat on my chest. It makes me feel exhausted and very ill. I have noticed that a lot of people don't seem to have the wheeze so I believe it is not a pre-requisite for the diagnosis of asthma - (So why do doctors always look at you sideways when you say you don't wheeze ??????)

    Anyway, I wondered if you thought there would be any point in having a spirometry test done at this point. I have never seen a respiratory specialist before. I do feel a lot better at the present time and it is not bothering me unduly, although I do get tired and do not have the energy I used to have, but I am older too.

    PS I have never smoked.

    Many thanks for taking the time to send such a comprehensive reply.

    Yvonne

  • Hi Poggins,

    I spoke with the Resp nurse specialist the other day on the subject of whether spirometry when well is of value and he said it is. If you are having epsiodes of extreme bad breathing it will give them a guideline of your best and worst. Not everyone wheezes with asthma you are correct but many Drs do look at you sideways when you say this as they think of status asthmaticus where you dont move enough air to wheeze. Has Cough variant asthma ever been mentioned? worth asking your resp cons.

    Hope you get some help soon.

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