Preventer inhaler and peak flow meter

Hi again guys

My nurse just prescribed me a preventer inhaler to use as well as a peak flow meter. I know how to use both of them but I was wondering if it mattered whether you take your preventer inhaler before/after doing your peak flow or does it not matter? (I completely forgot to ask the lovely lady who's my nurse).

Thanks again for any help/advice guys

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Hi again back!

Once again it depends on what your asthma nurse wants to monitor - you'll have to call her back and ask her to clarify. Are you sure you are meant to use the peak flow with the preventer? That seems rather unusual.

Many people do peak flows twice a day having nothing to do with reliever or preventers: once in the morning when they wake up and once in the evening. This is the most common use of a peak flow meter.

However, the timing really depends on what your respiratory consultant wants to monitor. Sometimes with brittle asthma, they want to monitor the average within-a-day change in peakflow. In that case, sometimes people do morning and midday peak flows because for many people peak flow is lowest on waking and highest at midday.

Some people are also told to use their peak flow meter whenever they feel like they are having difficulty and/or when they feel particularly good. This can help develop awareness of symptoms and how they match up to peak flow. It also helps the person helping manage your asthma put together a personalized action plan for you. The relationship between peak flow and symptoms differs from person to person. Not everyone has the exact same personal best, i.e. peak flow when you are feeling really good. Some people's best is lower than predicted and some people's best is very much higher than predicted.

As for peak flows with relievers and preventers

I was told told to do PFs with the *reliever* twice: once before and then again 5-15 minutes after. This was in order to check to see how the reliever was impacting my peak flow and to help me better understand how my peak flow matched up with my symptoms.

I've never heard of using the peak flow meter either before or after the preventer. Preventers don't normally have short term effects. Are you sure you were meant to use the peak flow meter with the preventer and not with the reliever or as a morning/evening sort of monitoring?

The only two reasons I can think of for using a peak flow meter with a preventer would be

a) you are using a preventer + fast acting LABA, e.g. Symbicort. Because the LABA in Symbicort takes effect in about 15 minutes, I suppose one might want to monitor peak flow before and after using it.

b) you are complaining of difficulty breathing after using your preventer and the nurse is hoping for some objective evidence of it by asking you to monitor peak flow before and after.

As you can see there are lots of possible uses of a peak flow meter so the only way you can know for sure is to call back the asthma nurse.

Good luck.

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Thanks for the information. I guess I should have been clearer: my nurse told me to do the peak flow readings every morning and evening (which seems pretty normal), she also told me to use the preventer when I wake up and before I go to bed. I don't think the preventer and peak flow reading are supposed to correlate, I'm just not sure which to do first (or if it even matters) at these points in the day

Thanks again for replying

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Thanks for the information. I guess I should have been clearer: my nurse told me to do the peak flow readings every morning and evening (which seems pretty normal), she also told me to use the preventer when I wake up and before I go to bed.

That makes much more sense.

Have no idea. I normally do the morning one right when I get out of bed - or try to - don't always remember! Then I just do it as soon as I can.

I definitely do the AM peak flow before I use the preventer - my preventer has a LABA (long acting bronccodialator) and on top of that, I'm supposed to use a neb before I use the preventer. Doing AM peak flow after the preventer wouldn't actually tell me much about the waking peak flow at all!

I would guess that if your preventer has a LABA you too should be doing the AM peak flow *before* the preventer. Same thing would go if you are one of those people for whom using inhalers sometimes cause a bit of bronchiospasm.

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Ah, I see. That makes sense. Thanks again for your help

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I would clarify your situation with your asthma nurse or GP as everyone is different.

Im on a reliever, two steroid inhalers, one with a long acting reliever, and tiotropium (spiriva). I always do my peak flow first (best of three blows) and then have my meds. I take my reliever first, to open the airways, and then take my steroid inhalers/tiotropium.

Lynda