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Asthma/peak flow improving greatly with inhaler--asthma?



We visited an allergist/immunologist recently because of my 8 year old daughter's dermographism. He decided to do allergy testing and found she is allergic to mold, dust, pollen, and our dog. We started her on Allegra and continued faithfully for two weeks and made some changes around the house without seeing any change in her. She was increasingly tired and complaining about stomach pain, nausea, and dizziness, which had been going on all winter. I then took her to the pediatrician and we are waiting on lab results. The pediatrician recommended switching to Claritin and testing out the inhaler. I had been watching her peak flow and noticed it was at the low normal level according to the charts I found online. She's about 52 inches tall and 64 pounds, and her peak flow varied from highs of 230 down to 180. Yesterday, her flow was below 200 again, so I went ahead and had her try the inhaler. After the inhaler, her peak flow went up over 250 easily and up to about 280. We did that twice yesterday and got those results. Having done it right before bed, I tested her peak flow in the morning and it was 250. The best yet without the inhaler. Does this mean my daughter has asthma? She had much more energy and good face color with the inhaler, too. Thank you for any insight you have.

Hello Kelli,
    I'd like to apologize for the delay in this response. All experts apparently had a technical problem. After I completely entered a response two days ago, it wiped out everything, in spite of me clicking save in the program. Tech-support has not responded to me, so let's try this again!
   To begin with, but the peak flow meter is not a diagnostic tool. It is a simple device for measuring airway resistance. The person who does have asthma has a tendency of losing perspective and how poor their breathing is becoming. It is great that you researched the chart for a peak flow meter, but the problem with it is, it's an average value not specific to that person themselves. The next step taken, if your child is doing very well, is to establish what's called their personal best. This is done by doing daily peak flow readings, I prefer about lunchtime. You take three measurements, recording the highest number. Doing this for two weeks straight, the best number in that stretch is your personal best. You've probably learned about the different zones. The green zone is 80 > 100 % of the personal best, the yellow zone is 50% to 79%, and the red zone is below this 50%. Combining this information with an Asthma Action Plan guides the treatment program for the patient. Until the age of 25, new personal bests are determined every six months. The lungs reach full growth maturity at the age of 25, which is why this is important to execute. An asthma action plan does not just look at peak flow values. It also gives symptoms based on decreased lung function, so there are times that a peak flowmeter may not be available, it guides therapy based on symptoms.

  Now, regarding making a diagnosis. First off, most asthma is due to allergies when you look at children. This is why your physician chose to do skin testing to see if there's an allergic pattern going on here. Next is a lung function test called spirometry. This is a small computerized device that is used similarly to a peak flow meter. It measures multiple aspects of lung function. It is repeated at least three times to get consistent figures. This is then followed by an albuterol treatments, then followed by a 15 minute wait before repeating additional spirometry three times. If the before and after results are greater than 12% or 200ml volume improvement after the albuterol, that is an indicator of reactive airway disorder....asthma.

  Finally, there are two blood tests I like to see. One is a measure of eosinophils, a type of white blood cells. Another test is for the immune system called IgE. Elevated value see there are very indicative of allergic issues with the patient, therefore confirming the diagnosis of asthma.

   Now, for brief that the physiology in the body's response to the inflammation. With asthma, there is always going to be some inflammation within the lungs. The body's production of cortisol, a natural steroid the controls inflammation, cycles through a 24 hour day. Levels drop significantly late evening through early morning, and rise through the daytime. This correlates with the best lung function during the midday, and the worst lung function overnight during sleeping hours. And asthma patient that is not properly control, his frequent nighttime awakenings generally due to coughing, and wheezing. This results in poor sleep due to poor oxygen transport in the body. The patient is much less energy during the day to execute normal activities. With the asthma being brought under very good control, quality of sleep is improved, night time awakenings do not occur, and the overall quality of life is tremendously better.

   Is important as medication use is necessary to have great control, it's only half the story. Understanding Asthma especially the triggers, is critical for success. Avoiding situations of exposure to the triggers tremendous reduces having asthma attacks from occurring. In addition, understanding the proper technique in using the medications for asthma is also extremely important. Much medication failure is not due to the drug, but due to not knowing how to properly use the device that the drug is administered with. It's also extremely important to understand what each of the medications actually do. Education is critical for success, the ultimate goal being improve quality-of-life. One can have a near normal life with asthma that is properly control. Near-normal, is because you have to take steps to make this quality happen, it just does not happen by itself.

   I hope this helps you, and if you further questions, feel free to get back to me. If the diagnosis of asthma is confirmed, I can provide you with guidance of proper therapy technique using the devices, as well as the resource for is an action plans. Finally there are two websites that I will provide  you to gain updated information on treating asthma.




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Marc Rubin, RPh Asthma Educator


I have worked directly with patients as well as caregivers for over 30 years. Have made presentations throughout Illinois educating school nurses as well as the teaching and coaching staff of public schools about asthma, and how they should respond to these students needs. Presented a public education program on asthma through the US Department of Public Health. Specialize in helping guide asthmatic patients to take control of their disease in order to live a near-normal, fully active life.


Practicing pharmacist for 40 years, specializing in asthma and COPD for 12 years. Developed nationwide education to nurses, teachers and athletic coaches regarding asthma and exercise induced bronchospasm. In addition, and closer to home. my daughter has asthma, and my son has exercise induced bronchospasm. In addition, I serve on the boards and committees of a number of asthma organizations: Sports, Exercise and Fitness Committee of AAAAI, Population Health Committee and Sports Medicine Committee of ACAAI, Sports Medicine Committee of the World Allergy Association. Board of Directors of the Chicago Asthma Consortium, Board of Directors of the Christopher D. Redding Youth Asthma Foundation, as well as the advisory board of a medical education company, Emmi Solutions. Directly involved in the creation of public education programs for asthma, COPD and diabetes.

American Academy of Allergy, Asthma and Immunology / Sports Medicine Committee, American College of Allergy, Asthma and Immunology / Population Health Committee and Sports Medicine, American College of Chest Physicians, American Thoracic Society. World Allergy Association, Chicago Asthma Consortium / Professional Development Committee, Christopher D. Redding Youth Asthma Foundation, and Respiratory Health Association of Metropolitan Chicago: Development Committee for AE-C prep class, and presenter.

AAAAI PowerPoint on the new guidelines for EIB (Exercise Induced Bronchospasm), AAAAI Powerpoint on Asthma in School Setting for Teachers and Coaches, Annals of Allergy, Asthma and Immunology: Transition guide for teens with food allergies or asthma going out of the home to live independantly.

BScPharm, RPh, (NAECB Certified asthma educator in 2002), NIPCO Certified Respiratory Care Pharmacist

Past/Present Clients
Emmi Solutions, Chicago Next Level Health, Chicago

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