Always trying to figure out why my asthma is so difficult to control, I decided to look at my daily peak flow numbers, neb treatments and symptom data over the last 3 years to see if anything stood out. This is what emerged:
Despite being on 1000mcg of inhaled inhaled steroids and a long acting bronchodilator everyday, which is the standard treatment regimen for severe asthma, my peak flows drop 80 to 100 points on average EVERY 3 to 4 hours around the clock, without rhyme or reason, continually putting me at the border of my yellow and red zones.
( As a reference, my green zone is 280 or better, my yellow is 210-280, and red is below 210)
9am: peak flow check = 200-220 After neb treatment 280-300
12pm: peak flow check = 200-220 After neb treatment 280-300
3pm: peak flow check = 190-200 After neb treatment 250-280
5pm: peak flow check = 230-240 After neb treatment 250-260
7pm: peak flow check = 220-230 After neb treatment 260-280
12am: peak flow check = 180-200 After neb treatment 240-260
4am: peak flow check = 200-220 After neb treatment 260-280
As you can see, my airways open up after taking a neb treatment, but the effect is generally short lived. When I do my daily walks, my peak flows will drop in less than an hour after pre-nebbing.
These constant fluctuations in my peak flows are usually accompanied by some degree of perceivable chest tightness or shortness of breath, and it’s this sudden feeling of chest tightness that usually alerts me to check my peak flow in first place. On average this occurs about every 4 hours. As a result, I have to take either a neb treatment or several MDI hits of albuterol every few hours around the clock in order to keep my symptoms at a tolerable level. Not just one or two days now and then, but every single day…period! About the only time my peak flows seem to stay in my green zone for more than a few hours is when Im on at least 40mg of prednisone or IV medications.
Essentially I live in my lower yellow zone with occasional visits to the red zone. The way I know Im starting to flare is pretty much the same way most asthmatics know …my inhaled meds simply stop working, or they become less effective. My peak flow numbers will only improve marginally or not at all, which leads to more shortness of breath and the need for more frequent treatments. If that cycle doesn’t break within a reasonable or tolerable amount of time, and/or my sats start to trend downward as well, I know Im in blown exacerbation mode and need to think about getting to the hospital before my lungs completely close up. Not a fun way to live.
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You are the only other person I know who was born with Asthma. I have stories of my mom and dad taking turns sitting on the porch with me all night when I was an infant, holding me up trying to help me breathe. That was in the early 1950’s in a rural town with no treatment for Asthma. My paternal grandfather had died when he was 52 as the results of a severe Asthma attack. In my teens and early adult years I was told I had outgrown it, but now has “come back” with a vengence!
We’re seeing this more and more, especially in females, where asthma returns later in life and is usually more severe. My friend and pulmonologist Sally Wenzel studies this.