Author Archives: Jackie Aim

Peak flow diary

A peak flow diary allows you to chart your asthma symptoms and peak flow readings.

Your GP or asthma nurse will be able to provide you with a diary.

It is helpful to take your peak flow diary to your asthma reviews to let your doctor or nurse see how stable your asthma has been.

You can also order or download peak flow diaries free of charge online.

Example of a peak flow diary

Download your own peak flow template:
Peak flow diary template [.pdf, 234KB]

Where do you get a peak flow meter?

Pharmacist demonstrating how to use a peak flow meter

Your GP or asthma nurse should be able to provide you with a peak flow meter.

It should continue to give reliable results for up to 3 years or as per manufacturers instructions.

Your peak flow meter should be cleaned as per manufacturers instructions.

How do you use a peak flow meter?

View text alternative

This is a peak flow meter and I’m going to show you how to use it.

Slide the pointer down to the bottom of the scale.
Lightly hold the meter on its edge in front of you, with the scale away from your hand.

Take as deep a breath in as you can.
Hold your breath. Place the mouthpiece well into your mouth and seal your lips firmly around it.

Blow as hard and as fast as you can for a second or more, being careful not to block the mouthpiece with your tongue or your teeth.

And I’m now going to show you how to do it.

INHALES

EXHALES

Your peak flow reading is show on the scale against the pointer.
Make a note of the reading and slide the pointer back to the bottom of the scale.

Blow in 3 times and make a note of the reading after each time, and then compare the highest score with your action plan.

You will soon get to know your own normal readings.
You should take the peak flow reading twice a day, morning and evening.

If you become unwell, one of the first signs you might notice is a change in your peak flow reading.

If there are big differences between your morning and evening readings, or if you start to wake at night with a cough or a wheeze, this could be a sign that your asthma is worsening and you should seek medical advice.

Stand up if possible or sit up straight.
Put the pointer to zero.
Hold the meter as per manufacturers instructions, ensuring fingers are not obstructing the scale.
Breathe in as deeply as possible, seal you lips firmly around the mouthpiece then blow out as hard and as fast as you can (like blowing out a candle).
Be careful not to block the hole with your tongue or teeth and try to avoid coughing or spitting into the meter.
Your peak flow is shown on the scale against the pointer. Note where it is and slide the pointer back down to the bottom of the scale.
Repeat this three times, the readings should be about the same.
Record the highest of the three blows in your peak flow diary.

What does a peak flow meter look like?

A peak flow meter is a small hand held device used to measure how hard you can blow air out of your lungs.

There are various peak flow meters available which vary in size, shape and colour like the ones shown opposite.

What is a peak flow?

Peak flow is a measurement of how fast you can blow air out of your lungs.
It shows how wide your airways are at the time of taking the test.
It can be helpful to assess how well your asthma symptoms are controlled.

Reasons for difficult to control asthma

Description: A mature woman patient consulting a GP in the surgery consulting room.

Incorrect diagnosis
One reason for a poor response to treatment is that some people do not have asthma, but have another illness causing their symptoms.

Your GP may refer you to a respiratory specialist for further investigation to confirm asthma or look for an alternative diagnosis. Sometimes it takes time and a trial of medication before an accurate asthma diagnosis can be made.

Poor compliance
Poor compliance means not taking medications you are prescribed by your doctor. It is one of the most common reasons for a poor response or feeling your treatment is not working. There are many reasons for poor compliance:

Lack of immediate benefit – some medicines take a while to give the full effect.
Not fully understanding the instructions you were given.
Your asthma team did not explain everything clearly to you.
Fears about side effects.
Complicated treatment, you may be taking several medicines at the same time.
Lack of insight or knowledge about how asthma affects you.
Psychological problems, anxiety or depression.

Discussing your medicines and any concerns with your doctor or asthma nurse will help. Following the instructions for taking your medicine and using inhalers correctly is one of the most important things you can do to help manage your asthma successfully.

Damage to the lung
Sometimes if the lung structure has been damaged this may affect how medicines are taken in to the lung or the effectiveness of those medicines. A scan of your chest may show if there is a structural reason why medicines are not getting in to the lung where they are needed. Some people need high doses of medicine before they get any effect.

Smoking
If you have asthma you should not smoke. See the section on ‘Help to stop smoking‘ for advice on why and how to go about stopping smoking.

The holding technique

Some children will take their inhalers perfectly well without a problem. However if you are having difficulty with your child taking their inhalers , here is a technique you may want to try.
Wrap the child in a blanket or towel. Get them to cuddle up so they feel safe. Try to stay calm and reassuring. Get the inhaler ready.
Get the child to breathe in the inhaled medicine even if they are crying. It’s not ideal but it is important to change behaviour so the child gets the benefit of the inhalers. The reason you wrap them up is to protect you so your child can’t lash out and hurt you, and also to protect the child. You don’t want the child to have bruises because you held them to take their inhalers.
When you are holding the child be firm but try to stay calm yourself. The child should start to calm down as the inhalers take effect. They will start to learn that this really isn’t so bad after all.
It should take about 2 weeks to get into a good routine. As the child starts to relax and gets used to taking their inhalers, you can stop using the towel or blanket and cuddle the child on your knee. Make the task fun if you can.
The child will stop fighting because they know where the boundaries are with the inhalers and because they will feel better for them. Even very young children realise very quickly that the inhalers help.
Remember to give lots of praise when they behave well. Positive attention usually works better than arguments and stress for you and your child.

Emotional support

Child/ girl being shown how to use volumatic inhaler to treat asthma. Mother and nurse.

Small children are not physically stronger than you but they can be emotionally stronger. They know what buttons to push to get a response. If they start to cry and fight this makes the child cough and wheeze. They know that you don’t want to see them cry or cough or wheeze so you stop doing the thing that you think is to blame – the inhalers. But it’s not the inhalers causing the problem. You need to be prepared for upset for a week or 2 at the most to break the vicious circle.

If there was an effective treatment by mouth it would have been prescribed for your child first and you would avoid having to do this, but this is the treatment for asthma and wheeze. It is very hard to do but it will help your child. Get help from the practice or respiratory nurse. They know what you are going to have to do and they are someone you can call to talk to if it gets tough.