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    All about Peak Flow Meters
    What is a peak flow meter?
    A peak flow meter is a device used to measure how well a person's asthma is under control. The device measures air flowing out of the lungs, called peak expiratory flow rate (PEFR), as a person with asthma forcefully blows into the device. A peak flow meter, when used properly, can reveal narrowing of the airways well in advance of an asthma attack. Used mainly by persons with moderate to severe and persistent asthma, peak flow meters can help determine:
    • when to seek emergency medical care.

    • the effectiveness of a person's asthma management and treatment plan.

    • when to stop or add medication, as directed by your doctor.

    • what triggers the asthma attack (such as exercise-induced asthma).

    What are peak flow zones?
    Peak flow zones are based on the traffic light concept: red means danger, yellow means caution, and green means safe. Based on your personal best peak flow measurement (the optimal level of your lung function), your three peak flow zones include:

    • Green: 80 to 100 percent of your personal best peak flow measurement; asthma is under control.

    • Yellow: 50 to 79 percent of your personal best peak flow measurement; asthma is getting worse; you may need to use quick-relief medications or other medication, as directed by your doctor.

    • Red: below 50 percent of your personal best peak flow measurement; medical alert, take quick-relief medication and seek medical help immediately.

    The goal of the peak flow zones is to help you recognize when the asthma may start to become uncontrolled. The goal is to stay within the 80 percent value of your personal best peak flow measurement.

    How is a personal best peak flow measured?
    Each person's peak flow zones are based on his/her personal best peak flow number. To establish your personal best peak flow meter, take your peak flow measurement each day at the same time (middle of the day) for two to three weeks, when your asthma is under control.

    After recording your peak flow measurements for two to three weeks consistently, your doctor may also measure your optimum lung function with a spirometer (a device that can check lung function by measuring both the amount of air expelled and how quickly the air was expelled). The spirometer measurement may then be compared with the peak flow meter record to help set up an asthma management and treatment plan.

    Your personal best peak flow measurement may change over time. Consult your doctor as to when to check for a new personal best peak flow measurement.

    When should a peak flow meter be used?
    Peak flow meters should be used regularly to check how well the asthma is being controlled. In addition, the peak flow meter may be a valuable tool during an asthma attack, because it can help determine how well the short-term, quick-relief asthma medication is working. The National Heart, Lung, and Blood Institute (NHLBI) recommends measuring lung function during the following times:

    • every morning, before taking asthma medications

    • during asthma symptoms or an asthma attack

    • after taking medication for an asthma attack

    • other times recommended by your doctor  

    However, the peak flow meter is a tool to help collect information. The key to successful asthma management is communicating this information (the peak flow meter recordings, the severity of your symptoms, and the effectiveness of your medications) to your physician.

    How can I obtain a peak flow meter?
    Peak flow meters are available over-the-counter and without a prescription. However, always consult your doctor about obtaining a peak flow meter and for step-by-step instructions on how to use the device.

    If you are using more than one peak flow meter, but sure they are the same brand.


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    Exercise and Asthma

    Info courtesy of MUSChealth.com, an American site, but still relevant to the UK

    What is exercise-induced asthma?
    Most people diagnosed with asthma will experience asthma symptoms when exercising. In addition, about 11 percent of the US population who are not diagnosed with asthma will experience asthma symptoms, but only during exercise, a condition called exercise-induced asthma. Exercise-induced asthma is different from the typical asthma that is triggered by allergens and/or irritants. Some people have both types of asthma, while others only experience exercise-induced asthma.

    Asthma is a chronic, inflammatory lung disease that leads to three airway problems: obstruction, inflammation, and hyper-responsiveness. Unfortunately, the basic cause of asthma is still not known.

    How does exercise cause asthma symptoms?
    When breathing normally, the air that enters the airways is first warmed and moistened by the nasal passages to prevent injury to the delicate lining of the airways. However, for someone with asthma, the airways may be extremely sensitive to allergens, irritants, infection, weather, and/or exercise. When asthma symptoms begin, the airways' muscles constrict and narrow, the lining of the airways begins to swell, and mucus production may increase. When exercising (especially outside in cold weather), the increased breathing in and breathing out through the mouth may cause the airways to dry and cool, which may irritate them and cause the onset of asthma symptoms. In addition, when breathing through the mouth during exercise, a person will inhale more air-borne particles, including pollen, which can trigger asthma.

    What are the symptoms of exercise-induced asthma?
    Exercise-induced asthma is characterized by asthma symptoms such as coughing, wheezing, and tightness in the chest within 5 to 20 minutes after starting to exercise. Exercised-induced asthma can also include symptoms such as unusual fatigue and feeling short-of-breath while exercising.

    However, exercise should not be avoided because of asthma. In fact, exercise is very beneficial to a person with asthma, improving their airway function by strengthening their breathing muscles. Consult your doctor for more information.

    How can exercise-induced asthma be controlled?
    Stretching and proper warm-up and cool-down exercises may relieve any chest tightness that occurs with exercising. In addition, breathing through the nose and not the mouth will help warm and humidify the air before it enters the airways, protecting the delicate lining of the airways. Other ways to help prevent an asthma attack due to exercise include the following:

    • Your doctor may prescribe an inhaled asthma medication to use before exercise, which may also be used after exercise if symptoms occur.

    • Avoid exercising in very low temperatures.

    • If exercising during cold weather, wear a scarf over your mouth and nose, so that the air breathed in is warm and easier to inhale.

    • Avoid exercising when pollen or air pollution levels are high (if allergy plays a role in the asthma).

    • If inhaling air through the mouth, keep the mouth pursed (lips forming a small "O" close together), so that the air is less cold and dry when it enters the airways during exercise. 

    • Carry an inhaler, just in case of an asthma attack.

    • Wear an allergy mask during pollen season.

    • Avoid exercise when experiencing a viral infection.

    Recommended sports for people with asthma:
    According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), the recommended sport for people with asthma is swimming, due to the warm, humid environment, the toning of the upper muscles, and the horizontal position (which may actually loosen mucus from the bottom of the lungs). Other recommended activities and sports include:

    • baseball  

    • biking leisurely

    • football  

    • free downhill skiing

    • golfing

    • gymnastics  

    • hiking

    • short-distance track and field

    • surfing  

    • walking

    • wrestling

    Sports that may aggravate exercise-induced asthma symptoms include:

    • cross-country skiing

    • basketball

    • long-distance running

    • ice hockey

    However, with proper management and preparation, most people with asthma can participate in any sport.

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    More on medication
    Medication as treatment for asthma:
    The two types of asthma medications used to treat asthma include long-term control medication and short-term, quick-relief medication. Though the goal of both medications is to treat asthma symptoms, they are used for different purposes. Long-term control medication is usually taken every day to control asthma symptoms and to prevent the occurrence of asthma attacks. Quick-relief medication is primarily taken to relieve the sudden onset of asthma symptoms (such as during an asthma attack), and in cases in which the asthma symptoms only occur occasionally.

    The type of medication prescribed by your doctor to treat your asthma symptoms depends on the type and severity of your asthma, as well as your other individual medical needs.


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    Long term control medication
    Long-term asthma control medication may include inhaled anti-inflammatory drugs (medications that reduce or prevent the swelling in the airways) and long-acting bronchodilators (medications that open the airways by relaxing muscles around and in the airways that tighten during asthma). The goal of long-term medication is to reduce and prevent swelling in the airways that can trigger asthma attacks. According to the National Heart, Lung, and Blood Institute (NHLBI), long-term control medication may be recommended for people who:

    experience asthma symptoms three or more times a week.

    experience asthma symptoms at night three or more times a month.

    When a person first starts taking long-term control medication, it may take a few weeks for the medication to become effective. It is very important that long-term control medication is taken every day, even if the person is feeling well, to continue managing the asthma at an optimal level.

    Long-term asthma control medication may include:

    • inhaled corticosteroids - anti-inflammatory medication that prevents swelling of the airways when exposed to asthma triggers. Steroids, which also reduce mucus in the lungs, are sometimes used to prevent and control mild, moderate, and severe asthma.

    • inhaled cromolyn and nedocromil - nonsteroidal, anti-inflammatory medications that are often used to treat children with mild asthma. (Both cromolyn and nedocromil cannot stop symptoms during an asthma attack. They only are used to help prevent an asthma attack from occurring.).

    • inhaled long-acting beta2-agonists - mainly used to control moderate to severe asthma and to prevent night time symptoms, these bronchodilator medications relax muscles around the tightened airways so that the airways reopen. These medications do not reduce swelling, so they are often prescribed along with an anti-inflammatory medication, such as an inhaled steroid.

    • sustained-release theophylline or sustained-release beta2-agonist tablets - bronchodilators used to prevent night time symptoms. Theophylline needs to build up in the blood stream over time to be effective in treating asthma.

    • leukotriene modifiers - these medications block the action of chemicals called leukotrienes, which occur in white blood cells and may cause inflammation and narrowing of the airways. Leukotriene modifiers cannot stop symptoms during an asthma attack. They only are used to prevent an asthma attack from occurring. Leukotriene modifiers seem to be more effective in people with aspirin-sensitive asthma (a type of asthma triggered by an allergic reaction to aspirin or other nonsteroidal anti-inflammatory medications).

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    Quick-relief  medication
    Quick-relief asthma medication quickly relaxes the muscles in and around the airways that tighten during an asthma attack. The sooner a person takes quick-relief medication at the onset of asthma symptoms, the faster the asthma will be back under control. Although quick-relief medications may relieve symptoms, the relief may only last about four hours. It is important to note that quick-relief asthma medications do not keep symptoms from recurring. Only long-term asthma control medications can help prevent the recurrence of symptoms. Some people with severe or frequent asthma may use both types of medications to control their asthma (as advised by their physician) - the long-term asthma control medication to keep the inflammation controlled and the quick-relief medication in the event of an asthma attack.

    When using more and more of the quick-relief asthma medications to obtain relief, the asthma may become uncontrolled and an adjustment of the long-term asthma control medication may be necessary. Always consult your doctor.

    Quick-relief medications may include:  

    • inhaled short-acting beta2-agonists - short-acting beta2-agonists are bronchodilator medications to help relax muscles in and around the tightened airways so that the airways reopen. 

    • inhaled Anticholinergics - medications that block a chemical called acetylcholine. Acetylcholine can stimulate muscle contractions, increase mouth and lung secretions, and slow the heartbeat, resulting in an asthma attack.

      Your doctor may also prescribe short course of oral corticosteroids (in tablet or liquid form) during periods of flare-ups with your asthma. Oral corticosteroids are anti-inflammatory medications that may prevent swelling of the airways and reduce mucus in the lungs. Oral corticosteroids do not give immediate relief, but are often used together with your quick-relief inhaled medications to provide better asthma control.

      Short-term, quick-relief asthma medication may affect individuals differently. Your doctor will prescribe the appropriate asthma control medication based on your individual needs.

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    Inhalation devices
    Several types of inhalation devices are used in the treatment of asthma or other chronic obstructive pulmonary diseases, such as emphysema. Inhalers are often effective in delivering medication directly to the lungs, with less side effects than medications taken by mouth or injection. There are several types of inhalation devices. The type of inhalation device will vary, depending on your medical history, preference, and severity and frequency of the symptoms. Inhalers can contain anti-inflammatory medications or bronchodilator medications. The most common types of inhalation devices including the following:
    • metered-dose inhaler (MDI)
      The most common type of inhaler, the metered-dose inhaler, in most cases, uses a chemical propellant (chlorofluorocarbons, or CFCs) to emit the medication out of the inhaler. There are now some MDIs that do not use CFCs to propel the medication. Many new types of delivery systems are being developed. 

    A metered-dose inhaler is held in front of or inserted into the mouth as the medication is released in puffs. Consult your doctor for specific instructions on how to properly use a metered-dose inhaler.  

    • nebuliser
      A nebuliser is a type of inhaler that sprays a fine, liquid mist of medication. This is done through a mask, using oxygen or air under pressure, or an ultrasonic machine (often used by persons who cannot use a metered-dose inhaler, such as infants and young children, and persons with severe asthma). A mouth piece is connected to a machine via plastic tubing to deliver medication to the patient. Consult your doctor for specific instructions on how to properly use a nebuliser.


    • dry powder or rotary inhaler
      A breath-activated, non-pressurized dry powder inhaler that may be used for children and adults, this type of inhaler does not use chlorofluorocarbon (CFC) to propel the medication out of the device. Consult your doctor for specific instructions on how to properly use a dry powder or rotary inhaler.

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