Peak flow question

Asthma, chest tightness etc

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24/06/2005 at 09:11
I am being investigated for asthma as I've been getting chest tightness when I run, comes on after about 4 minutes of so.
Got my peak flow meter yesterday and this morning 6am it read 560. Went for a run without any warmup, chest quite bad and had to stop 4 times to clear it. Got back and it read 520. Is that normal, good or bad? Or mild? I know we need more data but just wondering. Isn't it supposed to go up during your warmup as the airways increase? What change should a healthy person get immediately on return from a run.
24/06/2005 at 16:09
Depending on your age, sex and height I would guess that 560 is normal for you. It would be interesting to see what your peak flow is at the time you have to stop during the run. I am not too sure if 520 when you returned is of any significance, a fall of <10% can normally be put down to day to day variability. Have a look at http://www.peakflow.com/top_nav/home/index.html this may give you a bit more info.
24/06/2005 at 19:45
I was told that if I had EIB or EIA then the peak flow would fall after a workout - they didn't say by how much - but I got the impression any fall is significant

High smog levels etc can't be helpful right now either
24/06/2005 at 22:44
trying to use a peak flow meter always brought my Asthma on.

Thry here: http://www.lifesource.co.uk/ (sorry, can't do links) for an alternative.

Apologies if this upsets any of the medics, or drug company reps.
24/06/2005 at 22:44
Thry = try of course. Did wonders for my breathing, didn't help my spelling at all!!
25/06/2005 at 01:32
hey Joe Volcano; i'm an A&E doctor and am personally interested in exercise-induced asthma. As Steven correctly points out, we'd be looking for a fall in peak flow of more than 10% to assume any significance (or conversely an improvement of more than 10% after taking salbutamol inhalers). You can check your predicted best peak flow on the excellent website link he's supplied: Steven-- an excellent site, didn't know about it, thanks!
Slowboy: no worries, you don't offend me; just as long as you don't rely on breathing techniques at all costs and come to A&E when you *really* need nebulising... ;-)

back to JV's question: of course, as any asthmatic will tell you, night-time and early mornings are never their best in terms of chest tightness and cough, so i would imagine if you're up for running at 6am, you're doing ok!
also, as an aside, i would place a large question mark over any readings you have today (on 24/6/05): at work this morning i saw five previously unknown asthmatics present with severe wheeze following a dramatic thunderstorm. it's to do with large amounts of pollen being dumped out the atmosphere very rapidly, apparently! i think everyone's peak flows will be down a little today...
hope this helps, yl
25/06/2005 at 07:59
Thanks for all your answers guys. Should I try taking the meter on the run and seeing what it says at the actual moment I get the symptoms, seeing as by the time I got back from yesterday's run I was already feeling better?
25/06/2005 at 19:40
Joe Volcano: would definitely take your peak flow meter out with you, so you can see your reading when you're most breathless. that'll give useful information when you go back to see your GP. hope it works out for you...

regards
26/06/2005 at 19:54
yorkshire lad - read your input with much interest as having had bad asthma attack during ill advised training session yesterday. Have been to A&E several times and nebulised, but found after effects - cramp/tacchycardia/anxiety so bad that try and avoid, even though putting self at risk. Normally max peak flow 420, goes down to <100 during severe attack.
27/06/2005 at 11:08
bear b.hind -- though i don't have asthma myself, and have never suffered the consequences of back-to-back salbutamol nebs, i would urge you never to leave your peak flow below 100 for any period of time. the British Thoracic Society define a peak flow of less than 1/3rd of your maximum as "life threatening asthma", so make of that what you will. i just think that the one way of increasing your odds of winding up in intensive care when your asthma is that bad is to hang on an attempt to ride it out at home...
Perhaps one way round your dilemma would be to consider asking your GP to give you a supply of prednisolone to keep at home, so when you feel trouble's brewing a day or so before you're in crisis, you can intervene early -- hopefully avoiding the need for nebs.
27/06/2005 at 11:21
Bear b.hind - sorry to hear yours is so bad. What sort of warm up do you do, is it lengthy and elaborate? do you get this 'refractory period' I've read about?

Meanwhile mine doesn't seem to be panning out as today I deliberately induced the symptoms in a run and measured the pf on the spot and it was constant both during the run and afterwards - about 560-570. So this theory (EIA) seems to be heading the same way as my doctor's previous theory (angina), namely a red herring. And I'm left in a state where I can barely get a running session done with no idea why.

27/06/2005 at 13:56
yorkshire lad, thanks. I Do have prednisilone. Sometimes though if get chest infection need antibiotics as well. This year for first time had exercise induced asthma of severity I normaly only have with infections, so got caught by surprise.

JV, thanks also. Found that usually I can run through early stages of athma, although feel totally carp. It eases as I warm up. Secret is to begin slowly and take walking breaks if necessary. Problem arose this weekend because I was with a group. Also some other runners have in past made snide comments about peeps who walk in early stages of distance races, find it quite hard to resist pressure to start too fast - especially as once happened the sweep vehicle was up by @rse for the first few miles.
27/06/2005 at 14:50
bbh - I find exactly the same thing. I have experimented with a warmup on the turbo trainer indoors but it doesn't always seem to work, although sometimes it delays onset a bit. I guess the air is much better (cleaner/more humid) for me indoors so doesn't bring the same benefits as an outdoor warmup. I don't train with others now but know what you mean. I also find that if one of my neighbours is out in the road you subconsciously spurt as you go past which is bad too!
27/06/2005 at 15:05
Yorks lad - no worries, have never been so bad I've needed A&E, but did have big problems with EIA for a lot of years before I tried buteyko - now I still use beconase & Ventolin to manage the problem but need to use them far less than previously, and can run without problems.

I did go through a long period when I needed a long progressive warmup (20 minutes plus) to avoid my chest tightening during exercise, so can sympathise with those who are finding this hard to build into their training - the temptation to take off too quick when running with others is hard to avoid.

The thing that worked for me in the end was to ignore the coach's advice to breath in and out once per stride, and get into a rhythym of breathing in for three strides and out for three strides, breathing right down into the diaphragm. It seems like this gives me the same volume of air going through my lungs in a given time, but without the effort of pumping it in and out at high speed - which is what always brought my asthma on.

Good luck to anyone who is struggling with this, it is bloody frustrating.
27/06/2005 at 21:15
Slowboy - true about breathing, most fitness coaches do not understand asthma so standard advice is to get as much air into lungs as possible, whereas out problem is to get it out! Find taking short puffs in followed by long exhales - breath in like a mouse and out like a lion - works for me. Still is a bloody bore and incredibly frustrating.
28/07/2005 at 20:52
Hello. Very interested in reading the above messages. Recently I went to GP for peak flow test (following wheeziness in race. I have just been prescribed vetolin Accuhaler salbultamol sulphate 200mg. I was advised to take prior to exercising. If I follow this instruction to the letter will end up taking a "reliever" virtually every day. Does this sound right? Other than in strenuous/moderate exercise don't have any symptons. Any thoughts or comments?
28/07/2005 at 22:20
Has your doctor got you to get a peak flow meter for regular use? And if so, what sort of readings are you getting?
30/07/2005 at 21:33
No. I've been tested a couple of times. Readings just below 500, the norm for my age and height is over 600. I had spyrometry test before and after inhaling a relevant. The after result showed a 12% improvement.
01/08/2005 at 17:36
Hi all,

My experience suggests you should be cautious about those predicted peak flow charts.

I started to develop wheeziness after/during running around May this year. My doctor took peak flow readings (around 580) and (taking into account height 5ft8 /age 49) told me that this was normal (ie. she didn't think I have asthma). She gave me a reliever (Bricanyl) just in case, which I then proceeded to take before and after exercise. Even with this, I was still wheezy after running, so I bought a peak flow meter and started taking readings. I discovered that my highest actual peak flow is 700 - not the 600 predicted. Taking several readings per day for about a week showed that the reliever was clearly working, but didn't prevent the symptoms coming on. So, last week, I went back to the doctor and showed her the graphs. She was surprised that my actual peak flow was so high but agreed that I was experiencing EIA. She has now put me on a cortico-steriod preventer (Budesonide) and I am now monitoring again. My suspicion is that I have mild asthma, which is provoked variously by hayfever, cold air and exercise. It's probably so mild that a non-runner wouldn't notice it, but to me, it's very obvious!

I am told that the preventer will take a while before it starts working, but I'll keep you all posted.

01/08/2005 at 17:40
Forgot to say that my lowest, post-exercise reading was 500 (ie. only 71% of max). Bricanyl normally brings it up again to around 650 in half an hour or so.
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