Lower than (my usual) average peak flow, and asthma nurse suddenly concerned.

Hi, new user here!

I've had asthma all my life, it's genetic, and I've been relatively symptom free recently! Usually, I notice it at night, or after running, but otherwise, I don't take my reliever (Ventolin 200 Accuhaler) at all.

During an asthma check-up, my asthma nurse said that my peak flow was ""quite low"", but it always has been! According to the Mini-Wright Peak Flow Averages chart, my peak flow should be around 410 (21 yrs, 162cm) - I've never reached that - my highest ever is about 390, and that's after a course of Prednisolone; my last peak flow recorded by the nurse was 370 (last March) - this time it was 330, which is quite low and I know that, but 370 is the highest average that the nurse has for me. I did explain that my peak flow level rarely gets close to the average unless I've just been treated for a chest infection - she told me to take my Symbicort (turbohaler 200/6) two puffs, three times a day - morning, afternoon, night. So I've been doing that - my peak flow has improved a little - I've reached 360 a couple of times now. But obviously, it's still not at my average - I never forget my Symbicort, and I'm not actually having symptoms, so as far as I can tell, it's well controlled. Do some people just naturally have a lower-than-average peak flow?

I guess I'm just looking for some advice! It seems like my nurse has suddenly become worried about my peak flow, and how much lower it is than the expected average, when I'm symptom-free, she's been my asthma nurse since she came to the practice about 16 years ago so I'm a little confused by it all.

I'm not having any symptoms at all at the moment, even at night-time, and I'm only taking my reliever if I do any running/strenuous activities. I don't see any way that my peak flow can reach 410, when it never has before - can peak flow ever (drastically) improve like that? I didn't think it could, but I didn't think about it until it was too late to ask the nurse.

Also, whilst I'm here, I've been asking to get my inhaler changed for a while now - last year, I noticed that my Accuhaler wasn't working as effectively as it used to, so I made an appointment with my GP who sent me for a bunch of tests (sputum sample, blood work, lung capacity test, more peak flow tests before & after inhaler, and a chest x-ray) which were apparently all ""normal"", all that happened was that my preventative was changed to the Symbicort (used to be on Seretide 250 Accuhaler) - I've mentioned that I sometimes find it difficult to take my Accuhaler when I am especially wheezy as I can't get a breath in deep enough and can also occasionally choke on the powder thus worsening my symptoms. I've been on the Accuhaler since I was hospitalised after going into anaphylactic shock 11 years ago - I used to be on a Ventolin MDI. I've mentioned all of this to the nurse and the GP, the difficulty in taking it when I'm wheezy and the fact that I do choke on the powder, but it's proving really difficult to get anyone to listen to me and address my concerns - introducing the Symbicort was a good move, but Symbicort is (obviously) not a reliever, so it's useless if I need to take my reliever. My technique for taking the Accuhaler has been observed by my GP, the asthma nurse, and also by the specialist I saw last year - they all say that my technique is perfect, but the Accuhaler isn't relieving my symptoms as well as it used to, and can sometimes make them worse - any advice on this, also?

Thanks for reading all of this, and I hope I can get some good advice!

Edit - Is this the right forum? Maybe it should have gone into the Medical forum? Oops.

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I don't know concretely enough to advise you, but I do know that PF is really variable for individuals. Since I've started meds mine has actually turned out to be well above what my predicted is (can now hit 510 whereas previously I was getting 400-450 at absolute max). So opposite problem to you really, where mine looked ""okay"" but wasn't haha. So I guess, it's possible for yours not to look okay but be okay for you.