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Does anyone else not use their actual best Peak Flow?

Paradigm profile image

I lost my peak flow from years ago (which I only know was well above predicted because the nurse erroneously told me I didn't have asthma). So, at my new surgery I stopped avoiding reviews and my PEF was 420, though I'd taken near maximum ventolin.

Anyway, a few weeks later I scored 440 but none of my other scores were that high, so instead it was based off the other higher score I'd got - 430.

Two weeks ago, I was feeling well and my PEF was easily 430-390 but I'd run out of pages in my book, so I recorded none of it. On Monday, I scored 450 and started recording using an app.

It's not a huge jump, but it would push a number of my scores from the green band to amber. On the other hand, I've got enough oxygen and such.

It's gradually gone back to about 370-340. I think this might be because I was away last week and unfortunately I think I'm irritated/allergic to the flat we now live in. I've not been as low as 300 in about a month.

24 Replies
EmmaF91 profile image
EmmaF91Community Ambassador

Hi yes PFs are funny things...

It’s normal for your peak flow to vary throughout the day so whilst my best is 630 (unusually good compared to my expected of 370ish 😅), I will normally be above 550. Therefore the peak flow measurements I use for my chart is 550 as my daily average and not my peak which, when well, I will usually hit everyday at some point. This then alters the numbers I need to reach for red or yellow zone and that’s what changes I need to make to prevent a drop.

If you know you are currently well controlled with no symptoms then keep track of your measurements and work out what’s the lowest you go during the day with no symptoms and no additional reliever, and work out what score you most frequently hit.

If you’re still trying to get control, as you find the best medicine for you, your peak flow will keep improving til it plateaus then you can work out your best and average.

There will also be technique changes to consider too, and if you’re unused to doing your peak flow you may still be a bit inconsistent with your technique (I still often blow a ‘bad’ one which I ignore and repeat!)

PF is just an indication of how you’re doing but not the only thing people look at. If you are feeling symptom-free then it’s just an interesting thing to do for yourself as you become aware of your body. If you are getting symptoms you may find that you don’t really drop your peak flow all that much initially, despite you feeling bad... it is just an helpful hint for you and medical practitioners to help assess how you are doing! Some people find it a useful thing to do, others find it irritating how much a&e rely on it to assess severity of attacks...

Hope that helps and doesn’t confuse you too much...

Emma x

Abc64 profile image
Abc64 in reply to EmmaF91


My best pf is 410, but these days I don’t make that. My maximum is 350. I’m on fostair 4 puff twice a day. Braltus once a day and montelukast. Plus ventolin when I need it.

Paradigm profile image
Paradigm in reply to Abc64

Thanks for your reply. Do you feel well at 350?

Abc64 profile image
Abc64 in reply to Paradigm

I have problems all of the time. I think that your body gets used to it.

anjyil profile image
anjyil in reply to EmmaF91

I did this when I was first diagnosed---I figured out when I was feeling good and what the average was for when I started feeling bad. Pretty much same--anything below 550 and I really start to regret anything I do that requires actual breathing XD, though good PF doesn't necessarily mean no symptoms. I stumbled on this on my own as I was confused about all this asthma stuff haha. Glad to see I went the right route.

Incidentally, I have noticed that going over my average best (560) can also lead to symptoms on most occasions...odd.

Paradigm profile image
Paradigm in reply to EmmaF91

Thank you - I've been a little confused as I've never really taken them (apart from nurse appointments with I've avoided for a long time). My technique has been fine when it's been checked but I do sometimes get a wide range when it's low.

The problem I've had is that I was put on steroids but I felt terrible a few days later and had low peak flow, but by the time I had my out of hours appointment (4-5 hours later) I was fine and my peak flow was near the top of my range.

The doctor insisted I was probably just anxious (but wrote viral to my nurse). He said not to take my ventolin unless my peak flow was low as I was overusing it (I couldn't get it to last more than a couple of hours).

My asthma nurse reckoned it was unlikely I'd have an actual attack. Usually I have intermittent asthma where I'm fine most of the time and then have a couple of attacks a year. She said I could take a break from PEF measurements if I wanted before returning to them. Within two weeks, I had an attack that last about an hour and a half- likely escalated by the fact I tried to treat it as though it was viral. I was out with my colleagues at a staff event and didn't want to disrupt it only to be fine again (bearing in mind, I've not been nebulised since a small baby and have always recovered by myself after a couple of hours). They'd just about decided to override me and call an ambulance anyway and sent someone else outside to tell me when I was finally getting better.

So. I am under instructions to continually take dinural readings plus when I feel bad/take my inhaler. I think the problem is that I still feel bad at the bottom of my green zone so I'm not the most reliable at knowing when I'm well.

I use my actual best because it's signifiantly higher than predicted. I've gone in before, really struggling with a pf of 350 and being told it's not that bad. Compared to predicated, it's not that bad, but with a best of 570, actually it's not very good.

I can however have a low pf and feel fine and another day feel terrible but have a fairly normal pf.

Paradigm profile image
Paradigm in reply to -Butterfly-

Thanks for your reply.

That sounds very frustrating. 350 is quite a bit below 570.

I've noticed that some days I feel much worse with the same PEF score than others. I think also how long I've felt bad influences it - when it seems likely to pass quickly it doesn't bother me as much as when I've been stuck feeling unwell for days.

At my last asthma review in January 2018 the nurse didn’t even take my peak flow measurement - saying that “they” don’t use them anymore to monitor asthma. Has anyone else been told this?

Paradigm profile image
Paradigm in reply to 3lle

My doctor said it wasn't all that important and to focus more on symptoms, but then the OOH doctor thought I was oversensitive to my airways so now I focus very heavily on PEF.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Paradigm

3lle I so wish that were true re the peak flow! I would be happy if they didn't use mine but it seems like most people I encounter still want to.

Paradigm, without being a dr that (what the OOH dr said) sounds like terrible advice from someone who doesn't get asthma! If your Ventolin isn't lasting more than a few hours, as you said above, then it's a sign that asthma is not doing well not you being 'oversensitive' or anxious, or means you are overusing it. Given that many people can end up in hospital with ok peak flows, telling someone to rely on peak flow to take Ventolin and assuming the peak flow is infallible is pretty dangerous. Your usual dr seems more switched on.

Sorry I know you probably know all this already and I'm ranting, but I do get annoyed about the rubbish advice some drs dish out. I really don't think it is safe or sensible to tell people this kind of thing, based on my own experiences plus Asthma UK's advice.

Paradigm profile image
Paradigm in reply to Lysistrata

Thanks again! I think they probably were wrong in that case, since I ended up having an attack less than two weeks later. The only advantage to it was that I didn't suffer with the side effects of ventolin so much in addition to feeling asthmatic.

I think I do know those things when well, but whenever I get unwell I doubt myself wait 'just a few more days'.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Paradigm

I do the same! I'm also overly sensitive to being given crap advice. I know perfectly well when someone is giving me dodgy advice but another part of my brain wants to believe it and will then react the way you did by.pretending I can breathe when I increasingly can't.

I record all my measurements on my iPhone there is a free ap called SaniQ where you can plot them it's really interesting you can add how your feeling i.e. Levels of wheeze etc . Also it's always to hand to share with the health professionals

Paradigm profile image
Paradigm in reply to shassh

Thank you! I have been using SaniQ for almost a month now - I just wish it showed graphs for you symptoms, so that you could see them at a glance rather than clicking into the log.

I rarely use mine I go off how I feel usually mine 650 plus. I get it done when I'm at the doctor's but that's it really.

Paradigm profile image
Paradigm in reply to DeanSamson

Thanks for your response.

Lysistrata profile image
LysistrataCommunity Ambassador

My peak flow is honestly a mystery and I can't rely on it that much. My best is 630 (predicted about 470) so I make sure drs etc know this because if I am at 350ish this isn't ideal.

However, I spend a lot of time in this kind of odd amber zone, and I have had similar peak flow readings mid-attack as on a day when I am doing ok and going to work. It just doesn't seem to be that sensitive for me, and I get very frustrated when it is treated like the be all and end all of asthma, and I'm told my lung function is fine and I can't be having asthma problems because my peak flow is ok! I measure my FEV1 at home as well plus the asthma nurse at the hospital has an electronic meter measuring both, and I have noticed that quite often my peak flow is way better than my FEV1, which these days rarely gets up to anywhere near my best, and drops more reliably in an attack.

For me where peak flow *is* useful is how it responds to Ventolin. It should go up, so if it doesn't move much or drops very quickly, that is a useful sign that something is going on more than the usual. If I'm in hospital, the first few nebs may not shift it up much but as I get better, it will start to get higher post-neb and stay there longer. That's a fairly accurate guide that I will be able to manage without nebs, and luckily the hospital where I go is aware of this too and works with me on it. Sadly last time I got the dr for whom predicted peak flow is literally the only thing besides wheeze that matters, so I was sitting there at about 350 and not improving with nebs and she decided that meant I was fine and could go home, because I didn't really need Ventolin. I couldn't talk well enough to persuade her... (Incidentally my FEV1 had been below 40% predicted at home which I did mention, but got a shrug and well we can't measure that here. Yes I know but does it not make you wonder...?)

Sorry for the rant. I hope this is vaguely useful - I guess I'm trying to say that my peak flow is not something I find especially reliable and my asthma nurse agrees, so if you don't find it that useful I wouldn't torture yourself with it, especially if the dr who knows you is ok with symptoms! Could you ask them to do you a plan to wave at OOH drs etc, based on symptoms and how long Ventolin lasts?

EDIT just seen you have been told to take the readings, but still wonder if it may be helpful to have an official confirmation/plan that you shouldn't rely on them if you are struggling?

Paradigm profile image
Paradigm in reply to Lysistrata

I do find your post very helpful and reassuring.

I think my nurse wants me to use it because I don't usually present according to symptoms and my PEF/oxygen might be dropping dangerously while I'm still avoiding medical attention and PEF is what I can measure at home. She said I *could* have been overusing it but seemed to feel that I ought to pay attention and should seek help if I felt similarly again.

That said, I did track PEF changes and my PEF did improve after 4 puffs of ventolin each time before dropping again.

Whereas the OOH doctor seemed to feel it was just anxiety. (Even if he wrote viral on the form.) The thing is, is I used to have severe anxiety and while I'm not saying I've covered every symptom variation, I've never, ever assumed/confused anxiety and asthma before.

The doctor also seemed to believe that I probably do wheeze but just can't hear it. (My hearing is not great.)

I think I'm doing 'okay' as late. I'm not sure whether measuring my PEF is making me focus on bodily sensations, but I just don't feel myself at the bottom of my green zone. Slightly higher and I feel fine.

I think it's also complicated by the fact I'm very atopic and triggered by viruses so whenever my asthma acts up I've probably also got post-nasal drip (making my throat sore when breathing) and a blocked nose stifling air on the inhale.

I've also noticed that when I feel well, my scores are usually very close together, e.g., 410, 400, 420 but when I don't feel well my best might be 380 but the subsequent puffs are much lower (although sometimes closer together to themselves than the first) - I've tried doing 6 or so puffs to see if I get other high ones but I don't. It's like I can get one good breath and the rest are buggered. Sometimes, I do get close poor scores but usually not.

I have been avoiding taking my inhaler unless I'm amber or feel particularly bad over a few days, so I think I'll try the reversibility thing.

Sorry about the rambling.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Paradigm

There is a breed of doctor who doesn't understand asthma at all and tends to essentially make.stuff up for anything outside the classic wheeze/low peak flow. It makes complete sense to me that if you have experienced anxiety and asthma you would know the difference. I don't have anxiety and stress goes to my stomach not my breathing, but I have a friend with very severe asthma who also gets panic attacks. She says there is no way she would confuse them as they feel completely different (and generally don't come.on together).

I can see where your nurse is coming from so the reversibility may work well for you as something objective but not just based on the number. Perhaps you could discuss working that into a plan? Having pieces of paper to wave at sceptical doctors can be very useful!

I also know what you mean about the descending readings. If I am.struggling it's very hard to do peak flow even though I might manage a vaguely ok number. My unofficial test.of getting better after an attack is whether I can manage 3 without half killing myself! I appreciate it when doctors can see that the effort in itself shows there is something up.

My dr still uses mine as does my specialist best 250 has been for ages have my ups and downs but find vit c helps

digg profile image
digg in reply to Gwen30

Hi Gwen30

I have recently started taking high dosage vitamin c to hopefully help fight off colds and flu, how does taking vitamin c help you, do you find it beneficial.


That's funny you mention that, I've had asthma since I was 15 years old and I maybe used my flow meter once or twice. When I'm having shortness of breath I try my rescue inhaler first and if that doesn't work I use my nebulizer, I know most people don't like the solution mix nebulizer but it's what they use in the Emergency Room as I like to try opening up my lungs at home instead. I'm 57 now and still don't use the flow meter, cause I know when I can't breath as I don't need some stupid meter to tell me what level I'm at. Just give me what's gonna open up my lungs, LOL

Interesting question. It was a low peak flow which first helped my GP to flag up that my tight chest and breathlessness was asthma not heart related. I monitor it from time to time as I don't have classic asthma with wheeze. From the chart which goes with the peak flow meter my best is within range for my age and height, but I was surprised last year when I had to change my preventer medication that my best PF increased quite a bit!

It is a guide for me and I certainly take notice if I need to take the blue ventolin inhaler more often and my peak flow is consistently lower. I rarely reach my best PF but I am mostly within the acceptable for my age and height range. My personal notes are that my best is 450, lowest 180, normal daily range 320 - 380 and if I drop below 280 then I need immediate medical help if my reliever inhaler doesn't work. It's a guide and actual symptoms are more important indicators I guess e.g. too breathless to speak normally or continued chest pain.

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