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Peak Flow and FEV1

What does it mean if peak flow is in green zone but FEV1 is in yellow zone? 

 

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  • K8sMom2002

    That is a good question … what does your asthma action plan say to do if your FEV1 is in the yellow zone? 

    More importantly, how do YOU feel? Do you feel you're in the green zone or yellow zone?

     

  • StephanieAnn

    I'm following my plan for yellow zone. Symptoms snuck up on me. Always surprised, though, that peak flow stays in green zone!

     

  • K8sMom2002

    I'd definitely talk to my doctor about this. Sometimes the smallest piece of information can provide a clue … How long have you been managing asthma? And do you have a device that measures FEV1 at home? Just curious …

  • StephanieAnn

    I have a digital peak flow meter that measures both. I was diagnosed almost 30 years ago but we've concluded that I've probably had asthma since childhood when I suffered from an "allergic cough." I have a doctor's appointment in 2 weeks and will discuss it with her – and I'll try to get in to the asthma clinic before then to get the most recent "official" readings. Thank you!

     

  • Jen

    Hi Stephanie Ann,

    Welcome to AAFA's asthma support forum.  You mention that coughing has always been your primary symptom.  Coughing is a .  Do you experience any other symptoms?

  • StephanieAnn

    Yes, though coughing is usually my first and primary symptom, I also get short of breath and wheezy.

  • Kathy P
    StephanieAnn posted:

    I'm following my plan for yellow zone. Symptoms snuck up on me. Always surprised, though, that peak flow stays in green zone!

     

    I have this same issue. I tend to cough and not wheeze. Some refer to this as cough-variant asthma. We've been discussing . If I'm wheezing, I'm already in bad shape! This took many years, and many conversations with the doc, to figure out that I can't rely on my PF reading alone. I can have green zone PF readings and feel like I have an elephant sitting on my chest! AND sound like I'm moving great air when the doc listens. But my PFT / Spirometry will drop in those cases. But I have no way currently to monitor that at home.

    So, with the help of my doc, I've been able to identify other early warning signs like that deep, dry, unproductive cough or chest tightness that tells me to use my rescue inhaler and possibly take a cough suppressant to avoid further irritation. One monitoring device I've added is an oximeter. I've learned that my O2 sat will dip a bit as I'm starting to feel some of those other early warning signs. But the doc really wanted me to make sure it goes back up after the meds.

    I recommend talking with your doc about what other symptoms to monitor and how you can best use the tools you have (whatever things your electronic PF meter measures). Set up ranges and actions on .

  • StephanieAnn

    Kathy, what you describe is exactly what I often experience! I remember trips to emerg where I'd be all but dismissed because my PF readings were in my green zone and my chest has sounded "fine" even though I felt miserable! With the digital PF monitor, I am now able to keep track of my FEV1 readings which are a better indicator for me. The oximeter is a good idea, too. I just got off the phone with my RT at the asthma clinic and I'm now looking at adding ventolin and pulmocort as a nebulizer treatment at home to try and avoid prednisone again (was on it twice in the fall). I'm currently on Symbicort for maintenance and reliever. 

  • K8sMom2002

    StephanieAnn, I'm a member of the cough-cough-cough club, too. I had no idea that all that coughing spelled asthma until I was diagnosed in my early 30s. I'd coughed that way my entire life and so had my mom. 

    I think you're on the right track with plans to talk with your doc and your calls to the RT. Keep us posted, and I hope you feel less miserable very soon!

  • Kathy P

    Hope the med change has you feeling better quickly! Are you able to get in to the clinic for a PFT? Or did they say not to bother?

  • StephanieAnn

    She didn't suggest coming in – I think she knows I'll be on top of monitoring things and will follow up as needed. Just waiting to hear if the med change is a go.

  • K8sMom2002

    Do you have a nebulizer at home already, or will you have to get one approved through your insurance? If that's the case, here's hoping it's quick!

  • K8sMom2002

    Oh, that's great! Will it work with the meds that are ordered? Some nebulizers don't work with some meds.

  • Jen

    Have you heard back about the meds?  I sure hope that the med changes help.

  • StephanieAnn

    Med changes have helped. Cough is REALLY loose now – so much so that I can hardly catch a breath in the midst of some of the coughing spells. FEV1 has come up and continues to rise. Tried going to work yesterday – didn't last very long! Just the effort of getting there and the little walking around I did had me pretty winded – I knew I wouldn't be able to teach like that! So, I came home and am staying put today, too. Long weekend here and hoping to be back on track for Tuesday.

  • K8sMom2002

    StephanieAnn, hugs on trying to teach while coughing — BTDT! Rest and giving the meds a chance to work will hopefully do the trick.

    What has the doctor suggested on managing the cough? My chest always gets really sore after coughing so much when my asthma has a bad flare.

  • StephanieAnn

    What is BTDT?? Haven't seen doc this round – I have an already scheduled appointment coming up in a week and a half. I'll ask her then. I'm thinking it's better to cough than let it "congeal" in my lungs! Re: sore chest – oh yeah and ribs and back…

  • K8sMom2002

    Oh, sorry! I meant Been There Done That. I apologize for my shorthand. We have some cheat sheets on here at this link and on (the smiley faces, etc.) here.

    On the cough — well, yes and no about letting it out. On the one hand, my doctor's a big believer in not suppressing a cough in general, because I can develop pneumonia at the drop of a hat.

    But on the other hand, since coughing can trigger my asthma and exacerbate a flare, there comes a point when she advises me to take meds for a cough to sort of interrupt the cycle. 

    But that's a plan of attack she and I have worked out over the long haul. I think it's a good idea for you to ask about that when you see your doctor. 

    What did your RT suggest about how long to wait or what to look for before you asked for an earlier than scheduled appointment?

  • StephanieAnn

    I like that – BTDT! I'm pretty good with many abbreviations but missed that one!

    Since I can now monitor not only PF but also FEV1 at home (digital PF meter), RT was OK with home monitoring. She has also called every day to check up on how I'm doing. I see her next week for a follow up and assessment prior to my appointment with my doctor. That way she'll have more information to go on. Also, I have a standing order for Prednisone which I filled when this started at the beginning of the week but haven't started taking. Hoping to avoid it with the other increased meds. 

    I know what you mean about coughing exacerbating a flare. Coughing is usually my first and primary asthma symptom, though I also wheeze when it's bad (like these days). I usually get a tight almost tickling cough which I can nip with my regular inhaler. Even those "attacks" have been few and far between in more recent years.

    This time, though, I woke up on Monday and started with a cough that was deep and very "rattly" and just progressed from there. This attack caught me by surprise. Having said that, I haven't been very diligent in recent years with monitoring my PFs. One reason for that goes back to my initial question on this post – my PFs tend to stay in my green zone (occasionally high yellow zone) even when I feel poorly. Now that I can monitor FEV1 and understand it better (thanks to this week's experience), I need to use my meter on a regular basis to keep track of what's happening in those small airways and maybe avoid another attack like this. 

    Going back to the cough, I do have something OTC that I've taken for cough in the past. Might try that today just to get a little relief – while continuing to monitor PF and FEV1. Also, I live in Canada now and some of the meds used in the U.S. for cough are not prescribed here for cough! I will talk with my doc, though, when I see her. 

    Thank you for all the support and suggestions.

  • K8sMom2002

    Oh, wow, didn't realize that there was a difference in cough meds in Canada and the US. That certainly adds a wrinkle to it. 

    I'm glad your RT is monitoring things right along with you — sounds like a good plan. 

    I can understand not wanting to start the Prednisone, so I think you talking things over daily with your RT and knowing that you will soon see the doc is a great way to figure out when/if you should start it. 

    Can your RT help you with suggestions on good available cough medicines that would be equivalent to what worked before? 

    And on the thanks — I know folks here have really helped me think through things and been there for me when times were tough. They've also been there to cheer me on when I got over a flare and to help encourage me to follow my doctor's plan so that I would have fewer flares. I think it helps to know that people are rooting for you!

  • StephanieAnn

    I think the main issue re: cough meds is that many of the meds used in the U.S. for cough also contain narcotics (and/or other "controlled" substances) that here are only used for pain. 

  • K8sMom2002

    on the happy that you found us! That's what I like to hear! 

    And yeah, on the cough meds with narcotics — that is a difference, I would imagine. 

    I am allergic to hydrocodone and several other narcotic pain meds, so I've steered clear of cough meds that have a narcotic ingredient. It's led to many, many interesting conversations with my doctor about what I could take for coughing that wouldn't create another problem, you know?

    I know in the thread , a couple of our members talked about a medicine that really worked for them. You might hop over there and ask them about it — benzonatate or Tessalon pearls. It's a non-narcotic cough medication. It works for some folks, but not others.

  • Jen

    StephanieAnn,

    That's great that the RT checks in with you every day.  I think it's a great idea to see if she has any suggestions on an OTC cough medicine. Or…you may even want to place a call to your doctor to see if they can recommend something.

  • Mandy

    Hi My Fellow Canuck!

    Coughing is my primary issue as well. And I tool have normal results as long as I am on Prednisone. 2 years with that little devil for me and no signs of being able to come off anytime soon.

    Coughing is a frustrating thing for sure but so glad to hear that you have a great RT that checks in with you. I have been trying numerous complimentary therapies as well and have found acupuncture, massage, and chiropractic treatment helpful (more relieving than anything). Just throwing that out there if you haven't already tried. I hope you find some relief soon!

  • StephanieAnn

    Hi Mandy!

    Where in Canada are you? I have regular massage and am considering acupuncture for migraines as well. It's been a few years since I've been to a chiropractor. Thanks for the suggestions, though! Just wondering if you've found and OTC cough medicine that works for you. On "normal" days, I can get a dry cough that my inhaler usually resolves. But when I have a flare up like this and now that it is very loose (as I improve), it's hard to know which way to go. When I get a coughing fit now, I can hardly catch my breath because it is so phlegmy. Better loose than not but would still like to quell the cough a little!

  • Kathy P
    StephanieAnn posted:

    I think the main issue re: cough meds is that many of the meds used in the U.S. for cough also contain narcotics (and/or other "controlled" substances) that here are only used for pain. 

    Some prescription ones are, but we also have OTC ones that are not. The most common one is Dextromethorphan. It is not a narcotic and, in the US, is not classified as a controlled substance.

    There is an Rx cough suppressant that my doc gave me the last time I had a persistent cough that was not responding to other meds. I can't take codeine, so that limits my options. The generic drug name is Benzonatate. (Cynthia also mentioned that above) It might be worth asking the doc about. It has been real life-saver for me! One of my issues is nocturnal waking usually due to post nasal drip. This suppresses that tickle that seems to cause it and keep me up coughing all night long.

  • StephanieAnn

    Yes, my comment was in reference to prescription cough meds. We also have OTC with dextromethorphan which I have used. I will ask the doctor about Benzonatate. I appreciate all the suggestions!

  • StephanieAnn

    Just looked up Benzonatate – I think it might be problematic for me as it is "chemically related to (local) anesthetics" many of which I'm allergic to! 

  • Kathy P

    Well drat! Hopefully the doc can clarify and help find something that will help.

  • K8sMom2002

    I think it may still be worth asking about. Perhaps it's not related to the ones that you are allergic to. You might also ask your pharmacist. My pharmacist has helped me with lots of questions like that. Also, many pharmacy software programs have flags which won't allow pharmacists to fill a prescription if it may be a possible allergy or interact with a drug you're already taking. 

    It IS a bummer if it doesn't work, though. What meds have you tried that really help? Does your doctor prescribe anything that will thin and loosen the mucus in your chest?

  • Mandy

    I am in Saskatchewan. So our crazy weather is taking its toll on me. Where are you Stephanie Ann?

    I have issues with cough medicines because I need to be able to get the mucous out. I produce it like a super power I developed tachycardia along this journey so taking any regular cough medicines aren't recommended.  I take guaifenesin to loosen up my chest at my Respirologist's recommendation. He went out of the box and has prescribed me acetylsyteine for the cough. I am just waiting for the pharmacy as they had to make it for me. I'll let you know if I notice a difference. 

  • Kathy P

    Mandy, we need to get you a cape! Or at least a t-shirt that says "mucus is my super power"I use guaif too to thin out the mucus. That can really help the mucus congestion. But sometimes I just a dry cough from who knows what! That is the cough that really wears me out if I can't suppress it.And I always have a stash of cough drops. I hate when I forget them in a pocket and they wind up in the wash.

  • StephanieAnn

    Mandy, I'm from northern Ontario – crazy weather here, too. Tons of snow this year (lake effect off of Lake Superior) and temps that bounce from very cold to above freezing. It was a mild damp spell early last week that set me off. More of that kind of weather continuing so I'm praying I can stay on top of things.

    Kathy, I know what you mean about the cough drops! Never leave home without them! I'm better now about emptying my pockets EVERY NIGHT so I don't end up with the cough drop (or tissue) in the wash! 

  • StephanieAnn

    It's funny, now that the cough is really loose, my FEV1 has come right up but my PF are lower! I think because every attempt with the meter triggers that loose cough. Nothing concerning, especially since FEV1 is better, but odd that I'm getting the opposite of what I started with when I first posted my question!

  • Mandy

    I think that's the frustrating part with the mucous. It has many effects. But glad to hear it's looser this morning. My chest is loose but I can't move very much without coughing my brains out. It's tiring.

  • StephanieAnn

    I know what you mean. I went for a haircut – gone about an hour – and I'm exhausted. Hack, hack, hack – and then I perspire from coughing so hard! Thank goodness my hairdresser knows me well and was OK with the coughing! Now I need a nap!

     

  • Jen

    StephanieAnn – I hope you were  still able to enjoy the haircut.  It is interesting how things have switched now that you have a loose cough.  I think I would jot that down as something to discuss with your doctor at your next appointment.

    Mandy – That would be great if the new med helps with the cough.

  • Kathy P

    StephanieAnn – I've seen that too. Once I start getting stuff loosened up, my PF will dip. I've never figured out why exactly. Does your electronic PFM keep all the data so you can show the doc and get his take on it?

    Hope you can move that mucus out and be able to stop coughing Mandy.

  • StephanieAnn

    Thank you for checking in! Though it is not gone, the cough has settled down quite a bit. Saw my doctor this afternoon and she was pleased with how my lungs sounded. The nebulizer treatments have definitely helped!