Peak flow and trial of treatment

[peppa37]

Hi I’m new here, just looking for some thoughts and advice...

Back in spring I had a virus, just a cold really, and ended up with a cough/throat tightness which lasted around 6 weeks. Meantime I received an appt for a shoulder Xray due to a muscular issue. X-ray came back fine but I was subsequently sent for chest X-ray because of the appearance of my left lung which suggested possible infection. X-ray came back ok and cough cleared up, but I developed a bit of a whistling in my throat/chest mainly early in morning and late at night, so I went to GP who listened to my chest and got me to do 3 peak flows, the highest of which was 370.

He gave me a peak flow meter and a diary to keep for 6wks - my best ever peak flow was 390, average around 370 and dropped as low as 310. I was still wheezing at times, and sometimes tight in the throat/chest.

I went back and he decided with my history of eczema, allergies and family history of asthma to prescribe clenil brown inhaler, 2 x puffs of 200mcg (so 400mcg) twice a day and to keep monitoring peak flow, he said I should notice an Improvement in the numbers if it is asthma. Anyway I’ve been on this since end of June and really the numbers haven’t changed much. Average 370, best ever still 390, I’ve used ventolin when feeling very tight in the chest or peak flow particularly low, and it’s gone up to 410/420.

I’m going back to GP but really I’m wondering if it is even asthma at all if there’s been no real improvement. I have palpitations at times also so wondering if something else going on.

Anyone else ever had a trial of treatment and no improvement in symptoms?

[Darceydoo]

Did he do a Lung function test? Also has he mentioned Silent Reflux?

[peppa37 in reply to Darceydoo]

No lung function tests - he just sort of assumed asthma? My daughter has had lung function tests recently and histamine challenge - however she has had lung surgery and a repair of diaphragmatic hernia so her lungs are monitored carefully. I guess maybe the GP will have some suggestions today when I go back re the inhaler etc.

[hilary39]

My peak flow rarely changes even when I'm in a bad attack. Peak flow meters and FEV1 on spirometry only measure the large airways but many asthmatics often have a lot of tightness and discomfort in their small airways. Peak flows are great to keep an eye on things but I'd get a spirometry check to see how your small airways are doing.

[peppa37 in reply to hilary39]

Sometimes if I’m hoovering or dusting I get the whistling thing however it does seem to be high up in my chest or even my throat. Do you think the peak flow of 370 is just normal for me then? I seem to be fine most of the time and sometimes it’s lower when I feel fine / higher when I have the wheezy thing. The thing that made me wonder is I took the ventolin a couple of times when I had the uncomfortable tightness and it would shoot up to over 400 almost immediately and the tightness disappears.

[WheezyAnne in reply to peppa37]

That sounds like your body is responding to a dust allergy and so antihistamine (or change of if already on some) maybe better to take before you do the cleaning, to reduce or stop your lungs from reacting. Just a thought. Wearing a cheap paper mask seems to help for a bit too.

[peppa37 in reply to WheezyAnne]

I do have allergies anyway to peanuts, dogs, mild hay fever, so it quite possibly could be that. But strange that my wheezing/whistling started after that viral thing in spring!

[WheezyAnne in reply to peppa37]

There are so many viruses around and some are worse than others and take a lot longer to recover from, but yes, spring is a long time. It could be silent reflux if early morning and night - try sleeping on a few pillows to prop yourself up a bit. There is another condition (the name of which escapes me at the moment), which I have heard is sometimes mistaken for Asthma which is something to do with the vocal chords. Sorry, just cant remember the name. We are not medically qualified to give you advice, these are my personal thoughts. Have you tried breathing ex exercises to try and reduce the inflammation? Keep drinking lots of fluids.

[peppa37 in reply to WheezyAnne]

Ok so the doctor is arranging spirometry. Seemed a little confused, but said she could hear a wheeze in my chest. I’ve to come off the clenil for 4 weeks then have that done.

[Lysistrata Administrator Community Ambassador in reply to peppa37]

Is it for reversibility too? That's the best way to diagnose asthma really but sometimes they get it mixed up with COPD where one reading is more helpful than in asthma.

Normal spirometry can vary a lot depending on the person and even the day, and it is possible it can look ok but you can do even better. So if possible ask if you can do it before then after taking the Ventolin (avoid taking that day before the test if you can) - even if the first result looks ok, as there may still be reversibility. (You may need to get politely insistent if they don't, but it is much more useful than just one reading without reversibility).

[peppa37 in reply to Lysistrata]

Yes GP did mention I would need to have something done twice, maybe that’s what she meant

[Lysistrata Administrator Community Ambassador in reply to peppa37]

Sounds like it - and the GP seems to be on the ball which is good! You may have to nudge the nurse though if they don't want to do both times but hopefully won't be an issue.

[peppa37 in reply to Lysistrata]

Thanks for the advice everyone on here. I’ll be sure to update. It wasn’t that I was really concerned about the symptoms as I don’t feel I’m in any danger - but it would be good to get to the bottom of it all and have some sort of resolution

[hilary39 in reply to peppa37]

I get the whistling in my throat all the time. If your peak flow improves with ventolin that definitely sounds like asthma! Hae you checked your peak flow against your height and age? peakflow.com/pefr_normal_va...

[peppa37 in reply to hilary39]

I’ve had a look at that chart and according to that, my average should be roughly 445 (5ft 6 and 36yrs). I can’t even get that with the blue inhaler! Only manage 370 on average, but strange that it hasn’t improved with 3 months of clenil.

[hilary39 in reply to peppa37]

My peak flow hasn’t changed for years even with different meds, starting xolair etc. just for anecdotal food for thought, I’d not sure what a doctor would say about it all.

I do understand being frustrated by peak flow charts and asthma action plans that don’t correspond to how we’re actually doing! There is often a gap between our reality and the prescribed treatment and parameters...

[Junglechicken in reply to hilary39]

I can never understand why in medicine we are all clumped together. To have asthma you must have a b and c sort of thing. We are individuals, our experiences of the condition is all different. My mum is a great example. Her PF is currently at 70% no symptoms at all. I’m dancing around 76-88% slightest little sets me off, sometimes it’s nothing that I’m aware of. In the eyes of a doctor my mum is the poorly one. I’m well controlled. Madness!

[Junglechicken in reply to peppa37]

Your personal best peak flow is personal to you and boils down to how you feel. Ideally it’s supposed to be one of the tools to gage the condition of your lungs. The guidelines work around “well” being 80% of your PB. Some of us have a higher than average PF but are very poorly and it’s also the case that you can feel fine with a lower PF. My mum’s is much lower than mine and she’s well. I’m symptomatic at the moment and my PB is 485.

[hilary39 in reply to Junglechicken]

It's so true that we're all clumped together! When people think of asthma they think of a little kid who needs a quick puff of his inhaler during a baseball game.

There is a doctor in the states named Sally Wenzel who thinks severe asthma should have a different name since it's technically a different phenotype and has different markers and classifications than other types of asthma.

I support that line of thinking because I think it would make it easier for people in my life to understand how limiting my asthma is. I feel frustrated being lumped in the same category as the mild asthma that affects hundreds of millions of people just a few times a year.

[Junglechicken in reply to hilary39]

So true Hilary 39. Have to say I never took my asthma seriously until 6 months ago. I fell into the “my asthma is mild so I don’t have attacks” trap. I always liken asthma to a volcano. It does all of these things and more. Stay silent for a long time, rumble every now again and/or explode. I’m such a Mt. St Helens!

[Hidden]

If your peak flow is ok and you dont respond to the inhalers then there is a chance it might not be asthma.

Is the whistling on inhalation or exhalation, do you have shortness of breath?

The symptoms you describe with the palpitations means silent reflux is a possibility like Darceydoo said.

[peppa37 in reply to Hidden]

Exhalation - but occasionally on inhalation too. Peak flow according to the chart is much lower than it should be for my age and height. But no improvement either after 3 months of the preventer so who knows! Maybe 370 is just me??

[Lysistrata Administrator Community Ambassador in reply to peppa37]

That preventer may just not help you or not be the right dose - it seems to be quite individual and often people need to try more than one and different doses before it helps. If your peak flow is going up after reliever that does sound like asthma as you can achieve something more than you can without it - a person with no asthma or well controlled asthma wouldn't usually see a change.

[Garden18]

Ventilin / steroids can cause palpitations.

Best to keep records & see respiratory clinic to monitor.

[peppa37]

Thanks for the info I wasn’t aware of that actually! Funnily enough since I’ve stopped the brown inhaler I haven’t had any palpitations.

[peppa37]

Hi - just to resurrect this thread if I can... I had the spirometry last week (with reversibility) and results today at GP... she didn’t show me the results but said they were suggestive of asthma and with my history of atopy and strong family history of asthma she wants to treat it. She mentioned that my results were 73% before and 82% after so a little bit of an improvement after ventolin. Because I reported no improvement in my symptoms with the clenil she’s prescribed fostair x 2 puffs twice a day. Just started tonight so will see how I get on!

[peppa37]

Ironically the wheezing had improved a lot in the 3wks before the tests!!! Now have a viral thing and I’m coughing constantly...