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Peak flow hit

OK-I'm curious-if you're having a bad asthma day and/or a flare, how much of a hit does your peak flow take?  A bad day can sometimes tank mine as bad as 100-120 points, a good-day will hit about 50.

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  • K8sMom2002

    Wow, that is a big hit. Didn't you say you logged them? That you had some gadget that recorded them?

  • Kathy P

    That's a pretty big drop. Have you figured out your ? My normal numbers are in the 450 range (which is pretty decent for my height and age). So, the doc helped calculate my yellow and red zones as percentages of that. I don't recall the percentages we used though.

    My peak flows don't drop much at all until it's really bad. So, tracking my PF's has not been very helpful for me. I cough, my O2 may go down and my HR goes up.

  • Pljohns

    I do-my peak flow meter is digital and it had software and a dock that came with it so I could download it.  It's no longer compatible with the version of windows but for the last 3+ years I've been keeping a log in an app.  It gives me the same functionality as far as reporting goes, I just have to manually enter it every morning. I know when I'm down 150+ points for a couple of days-time to add the prednisone and call the doc

  • Shea

    I would like more info about the peak flow device and where to get one.. that sounds really cool and might help me with knowing when to lower on prednisone!

  • Pljohns

    Yes, I do have my peak flow ranges for green/yellow/red-I can usually tell a doc what it's running-oddly enough, that's the one thing they relied on the last time I was in the hospital because I don't wheeze.  They ask me every morning what my peak flows were.  I normally run upper 400's/mid 500's but a good-bad day will drop me to 410 or less-457 is my break point from green to yellow.

  • K8sMom2002
    Shea posted:

    I would like more info about the peak flow device and where to get one.. that sounds really cool and might help me with knowing when to lower on prednisone!

    Shea, have you asked your doctor about this? I think it might be a great discussion to have!

    PLJohns, have you seen any patterns on why you have that drop? Is there a downward trend or a sudden drop-off? 

  • Pljohns

    Usually a sudden drop if its a weather change.  If the weather is up and down, it goes down in small steps and bottoms out about 100-120 points down.  I've been experimenting adding albuterol if the weather looks like it's going to change drastically and see if that heads it off-haven't really done it enough to tell if that's going to help or not.  Now, if it's been a doozy of a stressful week-like last week-I can take a nose dive of 80-100 points in one day easy, then it's time to put out the fire and throw everything at it to get it back up.  It never comes back up as quickly as it goes down-usually takes at least a week to come back up totally and if the weather changes, I get sick or its a bad week, that already low number takes yet another hit and then its a flat out struggle to gain that ground back without adding the nebs every 3 hours around the clock and sometimes hitting the prednisone too.

  • Pljohns

    Usually a sudden drop if its a weather change.  If the weather is up and down, it goes down in small steps and bottoms out about 100-120 points down.  I've been experimenting adding albuterol if the weather looks like it's going to change drastically and see if that heads it off-haven't really done it enough to tell if that's going to help or not.  Now, if it's been a doozy of a stressful week-like last week-I can take a nose dive of 80-100 points in one day easy, then it's time to put out the fire and throw everything at it to get it back up.  It never comes back up as quickly as it goes down-usually takes at least a week to come back up totally and if the weather changes, I get sick or its a bad week, that already low number takes yet another hit and then its a flat out struggle to gain that ground back without adding the nebs every 3 hours around the clock and sometimes hitting the prednisone too.

  • Jen

    I recall you mentioning some temperature changes coming your way at the end of this week.  Do you have a plan from your doctor to try to ward off peak flow issues?

  • Pljohns

    I have an asthma action plan and have been doing it for over a week and still headed downhill.  After days of nebs and finally hitting them every 3 hours around the clock, adding every trick I have in my bag-and all of the meds I have in there too (except Pred), I'm STILL in the gutter.  I'm up a whopping 4 points this morning but still WAY down in the gutter.  DH laughs at me-if I'm down a little, I'm in the weeds, but if I've tanked really bad, it's in the gutter.

  • Jen

    Ugh.  Does your doctor have any ideas of things you could do differently?

  • Pljohns

    Right now, I don't have a doctor that I can get hold of. I'm sort of flying by the seat of my pants.  I'm pretty much on my own right now-not a good place to be.  I left  a message 2 days ago for the pulmo-hasn't returned it yet so that's one more reason for not being thrilled with him.  I see the new PCP tomorrow and pulmonologist next Wed-if I go.

  • Shea

    PLJohns, What meds do you do in your nebulizer?   Do you have a medication that deals with inflammation, or allergy? 

     

    My thoughts are more meds in the neb for inflammation (I use budesonide and will sometimes increase it from 2 x a day to more) to get out of the gutter (in hopes of not needing prednisine to get out of the gutter). 

    Also, more allergy meds if its the molds, fungus, mites from humidity contributing to asthma during the weather change.. but … If its just the thicker air, I would think trying to stay in the ac (to thin out the air) would help. 

    When I get too far in the gutter, honestly, pred is my only way out, but I have Churg-Strauss Syndrome, so I am a little different. I do get some help for stress from this supplement that has B and C And D vitamins and also has adrenal extract in it.. I get it from the health food store, and it gives me extra energy that helps sometimes when I am lowering on prednisone or going through a stressful time. I also hear, of course, exercise alone can boost things in the body that fight stress, so I try to get daily walks in, but this time of year I use the mall for its ac and wide spaces (stay away from the perfume sections) because its hard to get my heart rate too high outdoors without triggering my asthma sometimes. I will probably set up more indoor exercises in my home soon.. its on my to do list. 

  • Pljohns

    Shea-right now it's albuteral every 3 hours, budesonide every 8 hurs, duoneb (or albuteral and iapatropium if I don't have a duoneb handy) every 3 hours (I either do albuteral or duoneb), I'm on max dose of inhaled steroids (Qvar) twice a day anyway and that's up to 3 times a day now in addition to the budesonide. It's pretty much a max dose of steroids without prednisone.

    It does no good to try allergy meds as my particular type of asthma is non-allergic.  I"ve been tested for EVERYTHING and I"m not allergic to anything.  That's why I can cut grass, stay outside and pretty much do anything I want to without any issues.  The big trigger for me is and always has been weather changes.  When a front is coming through, I just can't breathe-my chest is super heavy and I just can't get a deep breath, have the shortness of breath and everything,  and if there is a temperature change in the middle of that of more than about 15 degrees, it's a double wammy.  My numbers will normally drop with just a weather change, but we've had them back to back to back and I haven't gotten recovered from one before the other blows in and my lungs just don't like that.

    I did a duoneb at lunch and now am coughing uncontrollably-and coughing for me is a bad thing-  I don't cough anything up at all and all the cough, cough, cough does is inflame, inflame, inflame.  

    I may end up doing albuteral again-less than an hour after the first one and that is never a good thing for me.  It turns me into a bawling, shaking blubbering fool and I don't know that I could take that at work.

  • Jen

    pljohns – Has the cough calmed down at all?  I hope your pcp has some ideas for you.

  • Pljohns

    Cough finally quit without having to do a neb but I came out of work to MUCH colder temps and a strong cold wind.  I talked to DH most of the way home from work and by the time I got in, I now have no voice at all and I can feel my lungs getting really heavy.  I'm glad I'm going to the doc tomorrow!  I really wanted this group because they do virtual office visits for simple things like sinuses etc. so if you don't feel like going in, you can set up a virtual office visit.  They also have 3 hours of no appointment needed sick call each day-and enough staff to handle it.  I just hope he is good and is willing to help me

  • Shea

    That's right, I remember now you saying you have non-allergic asthma. And yes it sounds like you have the max inhaled steroids. Glad you are seeing the doc, I hope they have suggestions to help. The only other things I can think of to help with weather changes is to create buffer zones to help your lungs transition from indoors to outdoors.. Like a garage or screened porch room that allows for a more gradual move from indoors to outdoors, or even a scarf or mask to prevent cold air shock? I do not know much about cold weather.. Very little experience with it… But scarves/ masks help keep moisture in if its dry, and keep the air warmer, and I do feel my airways/ lungs like me better when I leave through my front room allowing a small adjustment from one temp to the next. Good luck at your appointment!

  • Pljohns

    I saw the new doc this morning and I REALLY like him!  I've NEVER had any doctor stay with me for 45 minutes.  We covered everything about my asthma, what I use, how I use it and everything in between.  He said I need a pulmo BUT when I can't get to the pulmo, he is happy to jump in an help.  He told me I should have already started on the prednisone, so I guess I'm stuck with that starting tonight-yuck-.  He called in a new script for epi pens (mine is WAY expired but I've never had to use them), prednisone and told me to start singulair again.  Aside from that, he was at a loss for what to tell me to do with this asthma. At least he didn't tell me I was crazy because it's non allergic AND he didn't laugh at me when I told him I couldn't use inhalers because of the propellant.  

    He was quite impressed that I could tell him where my numbers are, what my meds are, what my normal taper is, how it acts and what all we've tried (crud-ALL of us could have done that so it didn't seem like a big deal to me that I could tell him that stuff).  He was glad that I had copies of past CT's and chest x-rays and all of my lab work and pulmonary function tests.  The best part-He's going to try and get my $800/month med for me as samples!  He ask when I was seeing the pulmo again and told me to have a LONG conversation with him about what I need to do prior to flying and if for any reason, we didn't have the conversation or if at any time I couldn't get through to them, to call him or send him a portal message and he would jump in and help but to NOT let it get like it was today before I did something.  He understood that it's not for lack of trying-and I told him that-I called pulmo 3 days ago and still haven't gotten a reply from them-he wasn't thrilled about that.

    He had no problem renewing my injectable meds that I keep as my rescue meds for my migraines (and not many will do that-they would rather you come in, pay a copay just to get the shot) and ask if I needed anything else renewed.  He seemed very knowledgeable and was very direct with what I need to be doing-and I told him he would have to be with me or I would do my own thing and over do it again-but was very personable and seemed to really care.  He said I was obviously very knowledgeable about my specific type of asthma and stayed on top of it-except taking care of it like I should (should have long ago started on the prednisone-17 out of the last 21 in yellow zones shouldn't be ignored).  All in all, SUPER appointment!

  • K8sMom2002

    Oh, my goodness, that doc sounds like a keeper! I love the way he helped you with the whole of you, you know? And that he understood you were not a text book case. Plus, he gave you specific things to look for as for when it was to start the pred. Did he give you a number of days in the yellow before you were to start the prednisone? (Our DD's allergist says 7 days for her, but that's because usually hers is triggered by an upper respiratory infection that ought to be on the mend.)

    Forgive me, but I've forgotten why you need the epinephrine auto-injectors? If you need coupons, you can check on Kids With Food Allergies for various different cost-saving programs

     And then if you'd prefer a , here's a blog post about that. And a  through direct delivery. Finally .

  • Pljohns

    Yes-he is definitely a keeper!  He didn't tell me how many days before I start pred-guess he assumed I knew that and I know I've needed it.  I just tend to avoid it like the plague because I've been on so much at such high doses.  When you come out of the hospital on 80 mg and it takes you 8 weeks to get off of it, it takes a toll.

    As for the epi pen-even thought my asthma isn't allergic asthma, I guess they figure I might just have one hit that hits all of a sudden.  He's the 3rd doc that has insisted I carry one.  Thanks for the links-I hope they filled it with the regular epi pen-I have a discount card that totally covers my $150 copay so it shouldn't cost anything.  I'll print the one for the auvi-Q just in case that's what they filled it with.

  • Pljohns

    They also like me to keep the epi pen because I tend to have anaphalatic reactions to medications.

  • K8sMom2002

    Ahhh … now that makes sense. I'd forgotten that you have a history of anaphylaxis to medications. Yup! You definitely need auto-injectors. I hope the links I gave you help! 

  • Pljohns

    Thanks-I actually downloaded the discounts but my pharmacy was able to fill the generic epi pen for $20.  I didn't make it to get it last night but will pick it up later today.  The 60 mg prednisone has kicked in and I'm up after 2 hours of sleep.  I HATE this stuff!  Thank goodness for and iPad and jigsaw puzzles-I can occupy myself and not wake up the house.

  • Jen

    pljohns – So glad you found a doctor that is thorough and works with you.  I hope you manage to get some sleep this weekend.

  • Pljohns

    Thanks Jen but no such luck-60 mg pred keeps me from sleeping-up at 1:45 Sat for the day and 3:45 this morning.  Makes for a long day and I don't know how I"m going to make it at work-between the nebs and being super sleepy-it's going to be a challenge.  The clinical manager for the new clinic that I manage is coming to see me tomorrow for 2 hours so we can go over some things so not only do I have to dress up and be on my feet, I can't be in this fog either.  

  • K8sMom2002

    PLJohns, I'm hoping you got some sleep and some rest … or were able to call in sick if you didn't! Pred can be so bad, but when you gotta have it, you gotta have it. 

    And yay on the generic for $20!

  • Pljohns

    No rest and I'm here all day today at work.  The new clinical manager that I will be working with will be here most of the day for us to get some things in order before the new clinic opens Monday so i didn't have a choice.  I have no voice, doing 14 various nebs a day and making by on no more than just under 2 hours a sleep at a time and no more than 4-5 for the entire night.  I hate prednisone but I'm on everything I can get on outside of being admitted.  

  • K8sMom2002

    Take care of yourself, PLJohns … Can you at least have a nap in the car or in an exam room during lunch?

    I have learned it does no one any good for me to push myself past the point where I wind up sick to the point of an admission … If mama ain't functioning, ain't nobody functioning, you know what I mean?

  • Pljohns

    I do and I agree.  Unfortunately, PT clinics are one person shops-I am the office manager but that entails all of the front office/meet and greet/check in/phones and everything else with the management side of the clinic.  There is no one to back me up and my new clinical manager will be here at lunch so I probably won't even get a break.

  • K8sMom2002

    Thinking of you and hoping that you get to go home soon and give yourself a break. Maybe your DH or your kiddos will help you out by having supper done when you get home. 

    A girl can dream, no?

  • Shea

    PLJohns your job reminds me alot of my old job (I was manager/supervisor at a residential mental health/substance abuse treatment center and met with clients, managed tech staff, was central communicator with therapists, directors, and owners), it was hard to get lunch in, hard to keep my desk clean, never a second of a downtime. What helped me was when I hired another office staff member who helped me, ran errands, and could cover for me during sick days/vacations, but had her own work load too. If you requested one, the person could float between the two locations too, and even be part-time or as a contracted employee if that works better financialky for your place of business.

  • K8sMom2002

    Shea, you always have the most excellent ideas … I hope that one day PLJohns can have something like that!

  • Pljohns

    That would be a God send!  My old job use to be that way-60+ hr weeks, no lunch, no breaks, still up trading e-mails at midnight.  This one is not bad at all-MUCH slower pace (that's the sole reason I took it), but it is a one person does it all thing.  The clinic I'm in until mine opens is extremely busy-they actually need 2 people, but I'm holding it down.  We do have floaters that can help out when we need it and IF they are available.

  • GigiGibson

    Yikes. I feel blessed. I share the lobby with my buddy and we tag team but have maybe three patients a week. We have vendors, packages and 130+staff to deal with. Our 85+ clinicians see patients across the state in their homes/facilities, we see few of them seldom. We support them in various ways. I recruit doctors/NPs and PAs, assist the pulmonologist and do overnight voicemails and deal with some vendors/resources. I also answer nurse questions. It's a great job, until someone dances in marinated in perfume, lol. Not impressive. 

  • Pljohns

    My last job was full on management.  I was totally responsible for a million dollar clinic, staff and physicians.  It was a 24 hr day job-almost literally-it was nothing to be still working and trading e-mails at midnight and I rolled into work every morning at 6:15 and didn't slow down all day.  That put me in the hospital 4 times in a year and 3 of those times within 5 months and then 30 days of medical leave. That was the slap in the face I needed to make some lifestyle changes.  

    This job is crazy right now but my new clinic opens next week and the new clinical manager is super.  I don't do over time, get lunch every day and when I leave, work is left here.  I might get 1 email a month after hours but that's it.  Definitely a change I needed to make and am so glad i did.  I hated to leave a company I was with for 6 years but after how they treated me, I knew it wasn't the place for me to stay.  

  • K8sMom2002

    PLJohns, I'm glad you have a job that helps you put your health at a higher priority, and I'm thinking that you're well clear of the stress and tension. 

    I had a job like that — and I was super glad to see the last of it, but my family was even happier. I still remember my last day at that job, when I turned in my Blackberry. My DD, who was 6 at the time, asked me that morning, "Mommy, are you SURE you're going to give that thing to them and not bring it back?"

  • Pljohns

    I am too and yes, the stress and tension is much better.  That's so funny about your daughter-my last day, our youngest son-age 15-met me at the door and gave me a hug and said "I got my Mom back".  

  • Pljohns

    Things have finally kicked in and number are up almost 80 points this morning and am blowing green for the first time in almost 2 months.

  • Pljohns

    Unfortunately no-between chic's bbw assault the other day and not even catching 5 min to do a neb at all yesterday, I'm sinking again.  Started throwing albuterol and duo nebs at it again this morning.

  • K8sMom2002

    Grrr on the BBW attack, and I hope that it's a temporary dip. I know you had to be pumped about seeing things in the green! 

  • Pljohns

    I hope so too-at least I'm away from chic that can't understand when I tell her ALL things that have fumes and ALL lotions/perfumes.  At least I"m alone in my new clinic-

  • Jen

    @Pljohns How have things been now that you're in the new office?

  • Pljohns

    So far so good-I have been up and down some but I think it's more from the weather.  I leave the air purifier going 24×7 in the office and so far, no problems.  My numbers are back in the 500's so at least I'm good and ready for my trip!

  • GigiGibson

    Wow! Thats awesome! 550 is my best. I'm usually around 430-450  in the am 500-550 after meds

  • K8sMom2002

    Gigi, it's so good that you know your numbers! Are you seeing them improve any over a long term trend? 

    And Lynne, that is soooo cool that your breathing is better and you're feeling confident about your trip!