SELF-MANAGEMENT AND PEAK FLOW MEASUREMENT

Most people with asthma need to monitor their asthma regularly and to have a plan of action to keep it under control.

Here we explain how people can monitor their asthma using something called a peak flow meter. It also includes an action plan, called a self-management plan, which you and your doctor or practice nurse can fill out together.

Peak flow

Peak flow is a measurement of how fast you can blow out.
Your peak flow measurement will be higher when you are well and lower when your airways get narrower. Peak flow measurements are therefore a useful guide to the severity of your asthma at any given moment.
Although how you feel and what you can do are important, it is peak flow which shows accurately how your breathing is changing.
The variability of your peak flow is as important as the size of the measurement.
Average normal peak flow varies depending on age, height and sex.
Modern asthma medicines aim to give you the best possible peak flow. It is also important to aim for stable peak flow. (Stable means little difference between morning and evening.)

Peak flow meters

There are several different makes of peak flow meter available on prescription. It is important that you use the same one all the time.

People who use peak flow meters

Most people over the age of seven with moderate to severe asthma will benefit from monitoring their asthma with a peak flow meter. It will also help your doctor because peak flow measurements make it easier to see how well your lungs are doing and whether your treatment needs to be changed.

How to use a peak flow meter

• Check that the marker (pointer) on the meter is at zero.
• Stand if possible, otherwise sit upright. Hold the meter level (horizontally), and keep your fingers away from the pointer.
• Take a big breath in and close your lips closely around the mouthpiece.
• Blow out as hard and as quickly as you can.
• Look at the reading, reset the marker and start again.
• Do this three times and write the highest peak flow on your chart.

Peak flow charts

When you have found your best peak flow, mark it on to a chart. From the chart you, or your doctor or nurse, can see how well your lungs are and whether your treatment is working properly. These charts are freely available through your doctor or nurse from your local Family Health Services Authority (Form FP1010).

Making sense of your peak flow

If your peak flow often falls below your normal it may be a sign that your asthma is getting worse. Similarly, bigger differences between morning and evening may mean your asthma is worsening; especially if you also start waking at night with a cough or wheezing.

Such changes in peak flow, when used in a management plan, can allow you to increase your treatment if your asthma gets worse.

Why measuring peak flow is very helpful

• It may be the only way of diagnosing asthma. Peak flow measured over several days or weeks may uncover a pattern typical of asthma; a single reading cannot do this.
• It may help to reveal what is causing or triggering asthma.
• Peak flow measured before and after treatment may show how effective the medicines are.
• Readings taken regularly can give you warning of an attack before it starts. With this knowledge you can start to increase treatment earlier to help avoid it.

The four ways to control asthma yourself (self-management plan)
1. Testing your own asthma

To find out how well you are, record the following on your peak flow chart on page 12 for two weeks:

• Your peak flow in the morning and at night;
• Whether or not you wake up at night with asthma symptoms (coughing, wheezing, breathlessness or a tight chest);
• How many puffs you take each day of your reliever inhaler.

Record any other information that you think might be important as well, such as contact with possible triggers, eg having a cold or being near a cat.

Take the completed chart with you when you next visit your doctor or nurse.

2. Understanding your medicines

Most patients with asthma need two types of medicine, usually in inhalers.

Preventers damp down the twitchiness and irritability of the airways, making them less likely to narrow when triggered. For this reason they need to be taken every day, even when you are feeling well, although it can take up to 14 days before they work properly. Preventers generally come in brown inhalers, but may be red, orange, yellow, grey or white.

Relievers are medicines that rescue people from breathing difficulties as they happen by opening up the airways. They generally come in blue inhalers and should be used when symptoms appear (or before exercising if exercise brings on symptoms). Steroid tablets may also be used for asthma attacks, too.

More information about these medicines is available in the 'Take control of asthma' and 'Steroid treatment for asthma' booklets available from the National Asthma Campaign To get the best results from your inhalers, you must use them correctly. Make sure your doctor or nurse shows you how to use them.

Your own asthma management plan (to be determined by your doctor or nurse)

This plan helps you to adjust your treatment according to the measurements on your peak flow chart. If you take quick action, you can usually prevent severe attacks.

Your doctor will write the ranges of peak flow which relate to each action.

The mini asthma-management plan

A 'credit card' version of your asthma management plan, which you might find helpful to carry with you at all times, is enclosed with the 'Self-management and peak flow measurement' leaflet available from the National Asthma Campaign. The leaflet also contains a more detailed version of a management plan (which will need to be completed with the help of your doctor or nurse), together with a chart for recording peak flow over a period of two weeks.

Update your management plan

Because your asthma may change as time goes by, your doctor may need to change your plan accordingly. You should visit your doctor or nurse at least twice a year.

It is recommended that a month or so after you start your self-management plan you should review it with your doctor or nurse.

Several scientific studies have shown that people with asthma who use plans such as these have better controlled asthma, less attacks and less need for rescue medication.