Saturday, February 06, 2010

My unique asthma flares

I'm having a rare asthma flare up today. The reason is because I hired someone to make a new bedroom in the basement for my son, and all the sawdust, and dust mites being spewed up through the vents is killing me.

Well, it probably doesn't help that I've been cleaning the upstairs bedrooms, but that's done now. Keep in mind I'm not as bad as I would be if I weren't on all these great new controller meds, although I can definitely notice my early warning signs:
  1. Tight chest
  2. Itching feeling in neck area
  3. exhaustion
  4. Urge to sneeze
  5. Nasal congestion
  6. Runny nose
  7. gut feeling
  8. Ventolin isn't working
  9. Can smell all the allergins in the air (a unique skill I have. More on this later)

Now, I've been meaning to talk about this for a while, but my asthma is unique in that no matter how I feel my peak flows do not change. For example, I just blew into my peak flow meter, and my PEFR was 690. Keep in mind my personal best is 730, so 690 puts me right in my normal range.

In fact, as I track my peak flows, I've noted feeling mild or "undetectable" shortness of breath on days when I've blown a 650, which is in my green range, and I've noted breathing normal on mornings I've blown as low as 550, which is in my yellow range.

This was not true when I was a kid. However, as an adult, my PEFR is not representative of how I feel. In fact, back in 1998 when my asthma was so bad I could barely take in a half a breath, and ended up in the ER, and later admitted for 10 days, my PEFR was over 700 for the entire stay. Go figure that out.

The Asthma Guidelines do note, however, that both symptom monitoring and peak flow monitoring are equally effective. The only problem with symptom monitoring is it's hard to really know it's time to give up and go to the ER (No, I'm not even close to that point, but I'm just saying).

If you monitor peak flows, and you blow a 60% of your personal best (for me that would be 438 or less), then you know you better take action quick and get better, or get your lungs to the ER.

Of course, whichever method you use, it's always hard to make the decision to go to the ER. It's easier to be modest and try to treat it yourself. It was this thinking that prompted me to write "Having asthma symptoms? Here's five tips to help you decide what to do."

So, needless to say, I have to monitor my symptoms as opposed to my PEFR. Now I still continue to monitor my PEFRs in a peak flow flowsheet I created (you can link to it here) just in case, although I do tend to slack in this area.

It's for this reason I'm usually relegated to being observant to my early warning signs as a cue that I need to stop whatever I'm doing and take action. However, still, that is easier said than done, especially when you're involved in a task you're enjoying.


  1. Hi Rick: Thanks for your intersting posting on peak flows. For many years my personal best peak flows were around 250 (adult onset at 38). I am 5 feet tall and now 57 and my personal best peak flows the last few years have been around 200 and can fluctuate throughout the day from 150 to even 220. But I can start having acute symptoms when my peak flows are at 200. I will use my albuterol inhaler even if my peak flow is up does ease the symptoms. Again, I have had numerous episodes of bacterial asthmatic bronchitis and my asthma acts a lot like a chronic bronchitis (I am basically non-allergic but prone to infections and have issues with irritants, smog, smokey air, etc.). Also liked your piece about when to go to the ER. I have definitely had that argument with myself many times about am I bad enough for doctor/ER/urgent care, etc.
    P.S. I am livelong NON-smoker

  2. I suppose one of the advantages of me being a lifelong asthmatic is I never new life any other way. I imagine getting adult onset asthma might make it all the more challenging. Am I wrong?

  3. Hi Rick:
    Well I had 38 years of reasonably good yes, asthma definitely put a dent in a lot of activities I used to enjoy...because I get SOB with exertion, I no longer can dance fast (which I loved to do a long time ago) hike up hill, or on a flat route at any pace that could keep up with healthy adults my age or even older, and bicycle at anything but a snail's pace, so I don't bike anymore. I do walk daily, but anything over about 2 miles per hour and I am stopped in my tracks. I can't be in any environment with lots of second hand smoke...nor around individuals as they smoke. Heavy perfume is also problematic. And when I am in a flare-up, my airway reactivity becomes even more pronounced and I am basically useless. So I did go through a period of mourning and adjustment for stuff I can no longer do like I used to. Very frustrating initially. I am also no longer working because my exacerbations can be quite prolonged and disabling. So yeah, asthma put a big fat monkey wrench into my career and activity plans. I also sing, and secondhand smoke at outdoor venues can really screw up my breathing and singing. And because my flare-ups can sneak up unpredictably, I don't book myself for featured performances, except rarely because I don't want a reputation as a flake for canceling a performance due to lung issues. I still do open mikes when I am at my "baseline" lung function and "stable". Right now, I'd say I've finally reached "acceptance" and am off my pity pot. There's people out there a lot worse than me. And I am grateful for all the stuff I can still do.
    P.S. For extra added attraction, I also have sleep apnea and use a C-PAP. In addition, I have chronic insomnia. And I am allergic to a variety of antibiotics, so catching bacterial bronchitis is always an adventure in finding an antibiotic that will work and that I am NOT allergic to. (I used to work with populations that often passed their infections to me. So not working is also somewhat preventative for me.)

  4. Wow..a bunch of sickies here....(just kidding).

    Hi Gayle, Hi Rick