Peak flow question

Asthma, chest tightness etc

21 to 34 of 34 messages
01/08/2005 at 18:50
I thought that my chest symptoms might be EIA but when I experimented with the meter there seemed to be little variation. I'm predicted to be about 630 I think and I'm normally 550 or so. re: your original figures, I have read that 10% either side is considered 'ok' which might explain why your doc thought you were normal.
01/08/2005 at 19:48
Joe V
Yes, I'm sure the doctor was right to say what she did, but it just shows that "normal" doesn't always mean much when applied to an individual However, graphing my peak flow variations showed exactly what was happening when I ran. Interestingly, the reduction in peak flow increased if I ran at 85% max HR or higher, and/or if I ran for an hour or more. I also found that starting slow tended to ameliorate the condition.

Good luck in finding out what causes your problem.
01/08/2005 at 22:05
Interesting to see this thread is keeping going! Running Bear -- just a few comments on your entries above. With regard to predicted peak flow values, you are completely correct when you say that the charts aren't always accurate to every individual. In my view, their chief value is to help identify what severity of attack a newly-presenting asthma patient is having -- i.e. someone who does not know what THEIR best peak flow actually is. As I mentioned above, a figure of below 33% of someone's predicted or best is potentially heading towards crisis stations from our perspective (=ICU), and if someone who's never had an attack before comes into A&E, i'd use a chart to have a rough idea of what they might be achieving on a good day. Plenty of people i see have worse peak flows than the chart says "they should have" and for every one of those people, there's someone else in your category, who are better than they should be. Your peak flow depends on your lung volumes and airway calibre, which is obviously greatly variable between individuals. Mind you, i'm most impressed if you say you can get 700 with a height of 5'8" at the age of 49 -- that's very high.
As regards your initial dealings with your GP, i would say that her declaration that you were "normal" because your initial peakflow was ok was slightly erroneous in as much as it's more to do with variability after exercise, than the absolute figure in itself. In my view, you 100% definitely have EIA as your peakflow fell to 500 after exercise. As to which inhaler is best therapy, I would agree a steroid inhaler is the one for you: if you're serious about your running, you need more than relief from symptoms when they develop -- you need to prevent their appearance in the first place, and hence if i was your GP, i would try you on low-dose steroids initially, building up their dose until you find you do not need to use your terbutaline (Bricanyl) at all: clearly you don't want to be using medication in the middle of a race!
Finally, am sure your GP is very pleased with you for keeping such meticulous records in your peak flow diary -- i meet so many asthmatics who don't even own a peak flow meter, let alone record things to your standard!
Keep us posted to how you get on, will be interested to hear in a month or so.

regards, yorkshire lad
02/08/2005 at 09:31
Thanks Yorkshire lad
It's good to know that I'm probably on the right track. To be fair to my doctor, she admitted that she had been quite taken aback by someone of my size and age me claiming to have asthma with a peak flow reading of 580 (I'd even run to the surgery to provoke the symptoms!). However she was, as you thought, pleased to see my graphs and has adopted the approach you suggest. I'm on 2x200microgram of budesonide daily and she advised me to monitor the dose until the symptoms are contolled and, if necessary, increase or reduce to the minimum dose that controls the symptoms.
06/08/2005 at 07:28
Thanks Running Bear. My capacity is well below yours despite being 6ft age 47. However similar to yourself my reliever leads to increase in peakflow of 10% +, sometimes up to 20%. I too have started monitoring my peak flows and have a follow up medical appointment in a few weeks. I don't know about you but despite a low peak flow I don't seem to have symptons during normal activity but when running particularly racing or strenous effort I get severe wheeziness. Fellow competitirs ask after my well being. It's definetly affeting my ability to sustain race pace, and makes steady running more difficult.
06/08/2005 at 09:24
Jogger, do you have any other triggers apart from exercise? It may be worth a couple of puffs of your reliever prior to a race but if that fail Montelukast(Singulair) is very good for controlling exercise induced asthma.
07/08/2005 at 18:45
Steven, Haven't noticed any other triggers. What is Montelukast (Singular)?
08/08/2005 at 14:20
It's medication used to control asthma symptoms which can be very useful when managing exercise induced asthma. It is not a substitute for your current medication, just an add on if your symptoms are causing specific problems. You can find all the info you need on the singulair website or discuss it with your asthma nurse/GP. Personally I would try 2 puffs of your blue inhaler via a spacer prior to a race and see if that helps. I assume it would not be classed as performance enhancing.
08/08/2005 at 16:49
Sorry to jump in on the thread. I'm asthmatic, and have been since I was a 4!! I very rarely have any problems except for hay fever season and sometimes if I have a cold.

As I saw Yorkshire Lad say earlier that people tend to get more problems during or before thunder storms. I really struggled with my asthma at a race a couple of months back which was on the last night of a very hot spell, about 30 mins after finishing there was a huge thunderstorm, so I guess that answers that.

However, I've noticed that my breathing got worse the other day just before raining started (during a fell race). Is it just thunderstorms that can bring this on, or raining in general??

This time of year I very rarely have problems with my hayfever. And I never usually get out of breath with my asthma during a run.
08/08/2005 at 17:08
hey Steven and the jogger

Pleased to see Steven that you tempered your initial enthusiasm for montelukast with a proviso in your second message! As you correctly point out, it's an extra therapy, to be tried in addition to salbutamol (or Bricanyl) and inhaled steroids. I'd also be wary of what's on their website, or indeed any drug company's website for that matter: you'll get a very polarised view, and I would suggest to The Jogger that if he or she wants a balanced answer, they should search more widely on the internet... in my opinion, montelukast has its place, but has a distinctly variable response rate -- for some people it does seemingly work wonders, but sadly these are quite rare from what i've seen -- about only 1 in 10, if i'm being honest. obviously this is just my personal observation, but that's the way i view it. do bear in mind that the way pharmaceutical companies make money is to promote the drugs which cost lots of cash (like montelukast) and attempt to detract from time-honoured treatments like salbutamol/beclomethasone (which cost pence). make of that what you will...

Jogger: as for what your GP will say, i predict you're heading down a similar route to Running Bear. i feel inhaled steroids are what you're going to need, based on what you've written here.

hammerite: glad to read your asthma's not too bad on the whole. as far as i'm aware any heavy rain can make symptoms worse, but thunderstorms are particular bad for the reasons i gave above.
08/08/2005 at 20:42
Yorkshire lad & Steven. Thanks for your comments. I'll continue to record peak flows and discuss with nurse in a couple of weeks. There's a local 10K next week which will prove an effective test of the effiacy of my current prescription (salbutamol). Incidentally I have noticed its impact on my peak flows is variable (5% to 15%+). I have an inhaler that packages the drug in 200mg capsules. I have noticed that taking two or three at once doesn't really bring any significant greater benefits than one in terms of peak flows. Steven you mentioned a spacer. What is it?
08/08/2005 at 22:02
a spacer is a kind of plastic-cylinder/spherical device that attaches to the inhaler and encloses the drug released when pressed; the principle is that you don't have to be quite so efficient in your timing of inhaling and pressing on the inhaler -- and that you can inhale about five times from the spacer device. Together, this augments the amount of drug getting into your lungs. I was told by one my former consultants that, even with optimal technique, you can only get about 10% of each puff into your lungs when applying the inhaler directly to your mouth, whereas with a spacer, you can get up to 25-30% -- some inevitably gets wasted in your mouth and throat whichever method you use. you can therefore see the benefit of these devices, and everyone with asthma ought to use one really. the only downside is that they can be a bit bulky (the bigger and better ones are about 20cm long), and aren't suited to be carried about during the day. they're realistically only going to be used by people using them with steroid inhalers, as you only take those morning and night, and thus leave that inhaler by your bedside. also, they're a bit of menace to clean, plus you've to get a new one every six months or so, which hardly anyone does.

the only thing which could make the above discussion pointless for you is that you say you get your salbutamol in capsules -- does this mean you have a dry-powder inhaler, rather than a liquid-puffer? if you do, you obviously can't use a spacer...
09/08/2005 at 22:21
great thanks for your help Yorkshire lad!!
10/08/2005 at 11:22
Hi All
Haven't checked in here for a week or so. Re the discussion about spacers, my inhalers are "turbohalers", which do not (according to my doctor) rely on timing the "puff". Instead, you load the inhaler by twisting it and then put the end of it into your mouth and inhale deeply. Seems to work well for me.

Re the steriod inhaler, I am continuing to monitor PF and, after a few days of starting on it I noticed an improvement. In the past week, ALL of my readings have been between 600 and 700 (even after hard exercise). Previously, I saw post-exercise dips as low as 500, and the norm was 550. I still find a post-exercise drop in PF, but not nearly as much. I also notice almost no wheeziness now.

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