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Peak flow - is there an average / age ?

Hello,

After a 10mn appointment, my GP told me I have asthma, and gave me a prescription for Ventolin and Steroids ("to take until the end of my life"). So far I have refused to use any drugs long term until I get a more thorough investigation.

So far my only symptoms are being prone to colds/flu/chest infections and a persistent dry cough (for over a year). I do not have a wheeze, and I do not have attacks. My lungs are clear (X-ray). I had one spirometry test which showed my lung capacity was at 67%. It increased by 15% after a couple of puffs of Ventoline. The Ventoline does not seem to have an effect on my cough. I always feel better when I exercise (it does not make me cough) and worse if I have to sit down for a long time, or when I sit in a reclining position.

Until I get referred to a Lung/Respiratory specialist, I am using a Mini Wright Peak Flow Meter and I report my readings on a chart.

1. Does any one know if asthma shows any typical patterns when using a Peak Flow Meter ?

2. My Peak Flow is around 400 on average, with occasional highs up to 425, and lows of 360, going down to 300 when I had a cold. Does anyone know if there is a particular Peak Flow average for a 56 year old woman ?

3. Also, based on the symptoms above, does this look like it could be asthma ? Sometimes I think it may be my vocal cords, as I have to clear my throat frequently.

Anyway, any comments, suggestions or advice would be welcome.

Thank you

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i am 31 and my best is 437 with a spirometer. my best with a peak flow is 400. does your medical centre have a spirometer you could be tested on?

do you have a post nasal drip into throa? that can give you a cough or clearing your throat.

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Thank you for your response.

I have had one spirometry test at the local nurse's office, I may be able to ask for a second test for comparison purposes ? I can't remember what the measurement was except that I was at "67% capacity".

I do not have a runny nose, so I presume I don't have a post nasal drip into my throat either. Or can you have a post nasal drip that is unnoticeable ? I have to clear my throat and I tend to cough when lying on my back or when reclining into a seat, so obviously there is some mucous and it must come from somewhere

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possible for it to come from food pipe if that is inflammed

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ah ok, is there a test for this or would it be obvious ?

I haven't noticed anything such as heartburn

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I'm not a doctor or expert but I seem to spend a lot of time having asthma and so will add my thoughts.

Based on what you say above, asthma is definitely a possibility. You do not need to wheeze or have attacks to have asthma (but many drs will tell you the wheeze is required which is incorrect according to medical evidence/guidelines). The reversibility suggests asthma - an increase of 15% after Ventolin is often used to confirm diagnosis. Of course, you may have other things going on as well which might be contributing to the cough eg post nasal drip as others have suggested.

Re peak flow: there are charts for average levels for age/gender but these are averages - your own may not fit this and observing your own personal best is definitely helpful (make sure to tell the doctors this/show them your charts). My best has always been well above my predicted. Peak flow often varies a lot in asthma and dropping with a cold is I think quite common, as is a lower value in the morning. However, from my experience and others on here, it's not a perfect measure and some doctors and nurses perhaps emphasise it too much (I've had attacks where it does all sorts of unexpected things). Some people find peak flow very reliable to tell how their asthma is doing and others like me find it's not that useful - for me I find it's only really helpful in how it responds to the ventolin is it should go up and if it doesn't my lungs are more grumpy than usual.

I appreciate you want to be cautious about taking medication and the GP has been rather gloomy in how they said it, but please bear in mind asthma can be serious especially if untreated, so I would be wary about waiting till you can see a specialist given you have had symptoms and tests suggesting something is not right and that asthma is at least a reasonable . explanation for it. Your GP may be very reluctant to refer if you have not tried the medications (I don't know what the other criteria are for referral or what you can ask for) and it may take a while to see someone even then - meanwhile you have colds and other triggers to handle if you do actually have asthma.

I say this to everyone but I strongly suggest calling the nurses on the Asthma UK helpline. Unlike me they are experts (respiratory nurse specialists) and provide very helpful information: they can talk you through things and advise on what to do and how to talk to your GP.

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Thank you very much for your thorough reply.

One question about reversibility.

Would a normal person also get an increase in lung function if taking a puff of Ventolin ?

Today, after I checked my Peak Flow (400) I took two puffs of Ventolin as a test and got readings of (430, 400 and 380). Obviously my airflow went up, but only once, then it decreased.

My throat has been sore for the rest of the day after that, to such a point that I had to abstain from speaking, or encurr the risk of losing my voice. Ventolin dried my throat and made me cough quite a bit throughout the afternoon.

I lost my voice for 5 days due to laryngitis after a train journey last October. This made me think that perhaps my issue is more with my vocal chords than with my lungs ?

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As far as I know, Ventolin does nothing at all for people who aren't experiencing bronchospasm, except maybe some side effects. A change of 15% definitely suggests there was some constriction of the smooth muscles around the airways and that the Ventolin was helping to relieve this.

However, it doesn't have to increase every time even if you have asthma. Sometimes, 2 puffs won't produce enough of a result. For me, this is the only actual useful purpose of my peak flow - if the Ventolin's not having an effect on peak flow, it suggests to me my lungs are really playing up.

At the same time, inhaler and peak flow technique play a big part. You said it was a 10-minute appointment with your GP - did anyone at any point show you how to use the inhaler or the peak flow meter? It's not intuitive and a lot of drs and nurses don't even know. If your inhaler technique isn't great, you might be medicating your mouth and throat with inhaler, which will quite possibly not do much for your lungs but may well give you a sore throat and cough! Your peak flow readings should also really be closer together than that - it's best of three but I think they are meant to be within (off the top of my head) about 20 ml of one another? So you should normally record the 430 as your best, but 380 is quite different from that for the same set of readings. Either your lungs found doing the peak flow hard (this is possible - another measure for me personally is how hard I find to just blow into a meter even if it gets an ok number) so it dropped with each blow, or no one has really shown you how to do the peak flow. When you did the test with the nurse they probably would have kept an eye to make sure you were doing it right, but it doesn't mean you can magically pick it up and do it at home if they don't show you how to do that and the inhaler.

When you go back to your GP, I would ask for someone to show you how to use the Ventolin and the steroid inhaler, and also ask for a spacer and be shown how to use that (if they won't, your pharmacist will show you). If you do decide to use the steroid inhaler it can affect your mouth and throat if you don't rinse, so I'd advise using a spacer to get it where it needs to be then rinse your mouth out.

Finally: coughing will affect your throat if you do it a lot, and vocal cord issues could be there alongside asthma. I had a constant cough for ages and part of that was asthma but part also was that the initial cough made my whole airway inflamed and kept me coughing. A respiratory physio showed me how to calm that down and now the only time I cough is when my asthma is getting worse or I have a cold. The asthma cough is fairly distinctive to me and others, and it *will* be helped by Ventolin which other coughs will not (my personal rule is if it scares other people and Ventolin helps, it's asthma. I have trained my colleagues out of offering me water which does nothing at all for the asthma cough.)

Many drs cannot wrap their heads around asthma coughs for some reason - they have sometimes heard of cough variant asthma but seem to think this can't happen alongside any other symptoms, like a tight chest. They often seem to think a cough might be a cold or infection, but I can now easily tell the difference even in other people. The asthma one can sometimes be described as a bark like a seal or dog, and is often worse at night. (Asthma in general tends to be worse at night).

Sorry - I was going to keep it short! I hope this is all helpful though.

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Between 400 and 425 is roughly the expected average for your age, and will vary according to height of the woman. There are plenty of charts online which can show you predicted averages according to gender, age and height, but as others have said, there is a great deal of variability, and it is your personal best that you should be using as a measure. Not for a stranger online to diagnose you but sure sounds like asthma though, and I suspect if you were to begin to treat it, you would see an improvement in your FEV 1 from the 67%.

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Hi there, Peak flow is a useful tool, but not be all and end all. My best peak flow is around 590, but when I get sick it can be in the 200’s. I am a 58 year old woman. I do a lot sport when I am well.

With regards to your GP, the reversibility test is first that they perform. But often they prescribe steroids for a trial period to see if they improve your symptoms. Inhaled steroids at a low dose are very safe and have negligible side effects. I agree with the other replies that you are unlikely to get a referral unless you try the treatment that your GP has recommended.

I would try and keep a peak flow and symptom diary and give yourself a one month trial on the meds. Then go back to the doctor with your results and have another chat.

Best

R

As a PS I have been using inhaled steroids for more than 30 years! Still here.

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Thank you very much.

You are right, I may have to go back to my GP and ask to try steroids for a limited time to see if symptoms improve.

This is something she declined to do originally when I asked. She said I had to take steroids for the rest of my life. A bit too brutal and radical for me.

I see you are sporty. I find I immediately feel better if I exercise (tennis, running, swimming). Does practicing a sport causes you attacks occasionally or it just makes you feel better / stronger ?

Best

C

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The frequent clearing of your throat is a symptom for Asthma just on its own. I’m 58 and have had Asthma since I was 30, all the things you describe are very very symptomatic of Asthma. My best spiro is about 380. The ventolin is to open your airways to help you catch a breath easier it won’t help a cough though. There is no absolute test for Asthma that’s why it’s usually your GP who diagnoses it based on what you tell him and what he hears in your chest. Asthma is a come and go thing, sometimes there’s absolutely o sign of it, at other times it’s blatantly obvious. Sounds like typical Asthma symptoms to me. If I were you I’d be taking my daily preventative meds straight away x

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Thank you for your reply.

If asthma is a come and go thing, can one also take drugs on and off ?

I do not have attacks, so perhaps I only need a boost from time to time ?

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You should have a preventative inhaler and a blue (ventolin) inhaler. The preventative inhaler has to be taken everyday usually twice in the morning and twice in the evening. Thus preventing an asthma flare. The blue, ventolin is for when you feel breathless. If you have been given a preventative one then for your own health you must take it xx

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Please take your daily meds. I had all your symptoms for years before new doc joined the dots and said Asthma! It’s a bit trial and error with the inhalers, can’t stop or change them without doctor’s say so, but when you find the right one that keeps the symptoms under control, it’s the best feeling ever.

Agree with Lysistrata. Phone or email the folk at AsthmaUK. Very approachable.

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There are certain enzymes in body that can cause ur symptoms. I have had, still have but they are better after using ketotifen or montelukast with cetirizine and gaviscon. They prescribed this to me in hospital from ent clinic.

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Thank you Krcz.

I am not sure what these medicines are for and how you combine them, but I will take note for the future.

Which particular enzymes are you referring to ?

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Montelukast blocks the action of leukotriene D4 on the cysteinyl leukotriene receptor CysLT1 in the lungs and bronchial tubes by binding to it. This reduces the bronchoconstriction otherwise caused by the leukotriene, and results in less inflammation.

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:-D

ok, I guess I have to improve my knowledge of biochemistry ..

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😁

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Sounds very much like my symptoms: incessant winter colds and always having to clear my throat until (after 6 years!) someone actually checked my lung function and, like yours, found it to be lower than normal for my age (66 then), but improved by 17% with ventolin. In my case, the diagnosis was asthma (20%) and fixed small airways obstruction (80%). I am also advised to take medication (Symbicort in my case) regularly to prevent further lung deterioration - sound a good idea to me!

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Thank you. Can fixed small airways obstruction be removed / improved ?

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Hi, I was born with asthma, there was no doubt. And the meds (inhalers) they have now are such an improvement over what had been. Of course prednisone is still a steroid. But the way they are prescribed now, is a little better. But I agree with everyone here. I’m in the states, I’m 55, female. I go to the Pulmonologist today as a matter of fact. I would give the meds a try. Now if you do start the prednisone and don’t like it, don’t just stop taking it abruptly, get in touch with your Dr. or a clinic/hospital. You shouldn’t drop from a full dose to nothing. And Ventolin, should help. The others here that have your level of symptoms know better than I. But my symptoms have been as mild as yours at times. But I have the almost constant clearing of my throat. I’m not absolutely positive that’s due to asthma. Because several years ago I was on a respirator, due to a surgery that went wrong. And that’s when it started. But give the meds a try. Especially if you won’t get to a more thorough exam without it. My best to you!

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