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Visit to asthma nurse...

Went this morning as still not feeling that asthma is controlled. It was an interesting experience!

1. She asked me what my peak flow normally was so I told her - 475-500, she then gave me a peak flow meter to use that only went up to 400 and I blew that to the max! I took mine out of my bag and used that instead and blew 440. She looked at her screen and said 'well the predicted peak flow for your age and height is 400 so 440 is really good'. I pointed out that regardless of the prediction, my best is nearer 500 - but she didn't seem able to get her head around that and repeated her statement about being a good peak flow compared with the predicted one.

2. She told me I shouldn't be taking my blue inhaler 3 times a day. I asked her whether she meant that I shouldn't be taking it or shouldn't need to take it; she meant shouldn't need to take it - glad I checked!

3. She gave me one of those looks when I told her that I took my blue inhaler before the brown one (as I had been advised to do by the GP) and told me that was outdated advice and just to take the brown one on its own.

4. The cough is not asthma but left over from the chest infection that cleared up two weeks ago - as is the tiredness and weakness.

5. I have been advised to drink plenty, use steam inhalations, 'treat your cold/cough as you would if you were not asthmatic'.

6, useful advice on how many normal breaths to take when using the spacer - 5 apparently - I was doing 3 for each puff.

7. Told that my blue inhaler will not help my cough (it does) as my cough is in my throat and not on my chest (she didn't listen to my chest but said she knew it wasn't because of the way I was breathing).

8. Have to spend the week doing regular steam inhalations, drinking hot drinks, taking inhalers as advised rather than as I was, then go back to see her in a week. If things are not improved then she will give me a long-acting combined inhaler - she is also going to give me my flu jab.

So apart from the clash of personalities (I decided she was not very confident) and struggling with the fact that the poor woman's eyes look in different directions at the same time (I have problems with body language that doesn't fit the 'norm'!), and despite her getting confused and saying things incorrectly sometimes, I have come away with an action plan and a bit more info.

And she weighed me but never said anything about losing weight or how my obesity might affect my asthma - and I forgot to ask the questions I went with!!

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I can't see how to edit my post! The nurse also said that peak flow was only a guide and that it can be fine but you can still be very poorly with asthma. I didn't really understand that but hey :)

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That's very true re only a guide, and glad she said that as felt she was a bit off re the predicted vs best PF. My PF doesn't drop as expected and I have severe asthma. I also have a personal best of 630 vs predicted of 470 which can be tricky with certain people who want to go by the averages, especially when it also doesn't drop the way you would.expect.

Just to double check, are you ok with steam lung-wise? I find it sets off my asthma so can't use that even if cough isn't asthma (and eucalyptus really does in case you were thinking of that). I feel like if your blue inhaler is helping the cough it may be at least partly asthma. I often get people trying to say my cough is not asthma (including my specialist asthma nurse once!) but I tend to disagree as I know how the asthma one feels, it is triggered by my asthma triggers and is helped by the reliever inhaler.

So maybe try the steam if it doesn't affect asthma but also be aware there may still be asthma there - after all, colds etc csn set off asthma so you do need to be aware and not just pretend you don't have asthma when treating it.

Glad you got some clarification and advice on other stuff!

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Hi

Yes different PF meters can show different scores, usually because one is ‘wearing out’, it’s why you should try to stick to the same one, unless you’re given a brand new one!

Like Lysistrata my best is 630, but predicted is about 440(I think), so compared to gen pop 450 is really good, but for me it’s not great - make sure you work your asthma around you and not the national guide! And yes PF is just 1 sign of a problem, however I’ve been really wheezy with a low ‘green’ PF and have a clear chest with a low ‘yellow’ one - think about the other symptoms when deciding if you need to do anything!

Yes treat the cold/cough just don’t forget that if it doesn’t calm down you may need to go back if it is caused by asthma - I’m not sure how much a would trust someone telling my my symptoms where from my throat not my chest if they didn’t actually listen to my chest just watched my breathing 🤨 - esp if she said the vent doesn’t help but you think it is!

I hope the steam works for you and doesn’t trigger anything (I know when I’m ill steam is a trigger 😒)

About point 2 - I’m glad you double checked! No a controlled asthmatic won’t need the ventolin at all, however if you need it, you need it!

Take you question list with you next week and ask then! 😉 I’m glad you came away with some useful advice and a plan!

Emma

PS to edit click the (•••) logo and in the pop up edit is an option!

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Nurses really do deserve to be paid more

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I’m envious of these high PF scores as my best is 390 and only get that extremely infrequently. More like 350 or 360 on a daily basis. I also saw my asthma nurse recently and unlike yours was encouraged to use the Ventolin inhaler more frequently if I needed it. ( I confessed to using it 3 or 4 days out of 7: I think she thought I could treat myself!)

I’m also on Fostair the combination inhaler (pink container) and that seems to be helping me to jog along more or less OK.

We discussed Peak Flow rates and she told me the average for my age/whatever is 386 so she was pleased that when she tested me that day it read 385. However I’m not sure what the point of testing in the middle of the day was as I’d already taken my treatment.

I do find the PF thing slightly confusing as I find that on some days when I feel breathless, the PF can read quite high and on other days when I feel fine, for some reason it’s low. I think when it’s low, I do think more about whether to take the Ventolin or not. My main reluctance in taking the Ventolin is that on top of the Fostair it can make me feel a bit wierd , almost dizzy.

It was useful to read that your nurse said 5 breaths with the spacer. I didn’t know that.

If you are struggling after doing the inhalation stuff I’d definitely go back and see her again. It’s strange because I was trying to think what treatment I was given for my asthma over 55 years ago, when I was a child and all I could think of was some sort of inhalation arrangement with a green powder. I haven’t seen that powder or heard of inhalation as an asthma treatment until reading your post just now so was really surprised that it is still a ‘thing’.

I’d be surprised if she didn’t put you on a combination inhaler when you go back. It’s been remarkably useful for me although there are a couple of drawbacks which I was only made aware of when a really impressive pharmacist told me about when he rang to check how I was getting on with it, the first time the Fostair was prescribed.. namely the need to rinse the mouth out after use.

Sorry, I’ve rambled on a bit. Hope you get your asthma better controlled and are not worrying too much.

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The inhalation was more to treat the cold I think - but, as others have said, I can't see how the two things can be separated out!

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Lysistrata and EmmaF91 are bothnso much more knowledgeable than I am, but I was a bit surprised by some of the things you were told, especially one. I tend to a tickly throat, and it can make me cough. I cough quite a lot, always have done, but sometimes from my lungs, sometimes higher up. Obviously it is good to treat your cold, but colds trigger asthma! So how can you separate them as firmly as that sounded? Given the parts of me that gets inflamed or react, I have been told more than once that your airways start at the bottom of your chest and ends at the tip of your nose. In other words, if your throat is a bit inflamed, it doesn’t rule out that your chest, too, could also be affected. There is as far as I understand it no exact clear lines between these different parts. So inflammation anywhere in our airways could be a hint that others are too, or could become.

I may have misunderstood what I was told, but it seems pretty important to have the whole picture, not just treat parts separately. They all interact.

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That makes so much sense put like that ie it can't be so.easily separated. I was trying to say something like that but admitted atm and brain is fuzzy. I just know that colds etc always set off my asthma, though sometimes not until the cold is almost gone. (Annoyingly I have one now - not happy as I feel I will get out then have another attack!)

Re the PF, I also find the reading can vary based on the mouthpiece. I seem to read lower on the disposable cardboard mouthpieces vs the reusable plastic ones.

I tend to treat more on symptoms but have been noticing some low numbers in the morning recently and decided to treat those as the symptoms can then follow.

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yes, when I first started noticing symptoms it was after swimming, and it was a low down sort of rumbling feeling when I breathed - I know quite a bit of anatomy and knew this was in my trachea where it branches off into the bronchus. I have decided that inflammation is inflammation no matter where it is in my breathing bits!!

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Yes, that makes sense, but I am still learning! I am just gradually recovering from an exacerbation/attack due to a cold. I have a friend who is a doctor and she has at times been immensely helpful, well, read me the riot act once when I wasn’t taking aboard how ill I was. It was good.

I spoke to her a couple of days ago for advice on how long it is likely to take my lungs to recover. I was saying my lungs weren’t infected, as though there was gunk and rattles (crackles and wheezing), the gunk was neither green nor yellow. My cold was a ‘head cold’ I said. She quite rightly pointed out that a cold is an infection, so you have infection in your systems, with bugs going about their business, and you cannot guarantee it has not or will not affect your chest. It made sense. And I am learning.

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Hey, very useful all this advice. Can I just ask what you mean in point 6?

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Yes, when using the spacer, you press the inhaler down to puff the medicine into the spacer, then you take normal breaths with your mouth around the mouthpiece on the spacer to take the medicine into your lungs: I was taking three breaths after each puff of the inhaler but the nurse said I need to take five after each puff to make sure I have all of the dose each time - I hope that is clear? :)

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Brilliant! Thank you :)

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