I'll start by saying I don't like using my reliever. Not that it causes side effects. Just because I'm not a fan of taking medicine in general. I'm the sort of person who prefers to wait out a headache rather than take aspirin.
About two three weeks ago, my doctor gave me a “lecture” on why I should use ventolin when I start feeling symptomatic and not just “sweat it out”.
There are two reasons for this from his point of view
a) by catching things early, we can avoid them escalating. And in particular escalating to the point where it takes more than two puffs to quell things.
b) it messes up his numbers – well, he didn't say that, but that was the point. He needs to know how often I'm feeling symptomatic and how long the reliever works to stop my being symptomatic. A count of how often I use the ventolin gives him a count of how often I'm symptomatic. If I don't use the ventolin in the first place, he has no way of knowing how long the ventolin would have worked.
It all sounds very logical and sensible, BUT every time I start feeling difficulty breathing I get into these mind games.
a) I think, sure I'm working a little harder to breath, but its only a little harder, so maybe its just in my head. If I ignore it, it will go away. Sometimes that does work. Most times it doesn't. I usually end up giving in and using it when I get to the point that there is something I need to do (errand, housework) and finding it hard to do. Or when it just plain hurts to breathe.
b) Peak flow as an objective measure doesn't work for me. If anything it encourages the mind games. According to the Mini-Wright website my “predicted” peak flow is about 420. However, for me, that's actually where I start getting symptomatic (verified by checking peak flow when I start feeling symptoms). This makes me say to myself “see, it really IS in my head”.
I'm a trained classical singer with a particularly forceful resonant voice so it would stand to reason that “predicted” is not personal best. It is hard to know right now what my own personal best is because I have no current benchmark. The best I've blown in recent days is 460, well above predicted. Years ago, when I tracked peak flow my personal best was more like 490-510. However, it was a different peak meter and I don't remember how it was calibrated.
Even if I did know the calibration, I wouldn't know what the current number would be. I was younger and so one might say my current peak flow should be lower now. Then again, my old best was also before I had a really good voice teacher and part of studying voice is learning to maximize force with minimal effort and air flow volume. So there really is no way of knowing what my current personal healthy best actually is.
Also, though I don't have any recent spirometry (asthma was very quiet for several years before this), I do have a copy of a very old test that showed that for me peak flow and FEV1 don't necessarily correlate: on the test I had a pre-BD FEV1 of 68% but a peak flow at 94% predicted.
Intellectually, those are both good reasons to not use peak flow as an “it is in my head” excuse. None the less, I do.
c) Partly because easy to get numbers like peak flow don't work, my doctor is relying very heavily on my symptom reports to make decisions. If I need the ventolin less than every four hours for a stretch of time (e.g. half a day or more) that's our current sign I'm in the yellow zone and should call in to discuss whether medications need to be adjusted.
I react to this by turning the four hour mark into a competition: can I wait it out to four hours? I don't really want any more medication if I don't absolutely need it. My doctor is pretty good at not turning bumps on the road into an excuse to throw more drugs at me. Still, I'm not real crazy about giving him any more reason to think about it than necessary.
I don't want to understate symptoms because that is clearly not smart. On the other hand, I don't want to over read them either because I'm not real crazy about how many drugs I'm on and certainly don't want more.
On the other hand, when I do use the ventolin based on symptoms rather than hold out until some fixed time frame, I'm a lot more functional overall. It is easier to focus on getting things done, when breathing isn't a low level form of calesthenics.