Asthma in 7 year old. Peak Flow

[Lollyice]

Dd has had a cough for the last 3 months. Pharmacist suggested seeing the doctor to see if it could be asthma.
The GP has given dd a Peak Flow Meter, inhaler and spacer.
We are to record the highest reading from 3 'blows' into the meter and record the result.
We have only done one reading but I am worried it seems quite low.
Does anyone have any idea of a healthy reading for a 7 year old please.

What was the reading and did she do a fast hard blow not long and drawn out.

What was the reading. Did she sit/stand straight, no slouch, take a really deep breathe first, and properly blow- short and sharp? Have you done it three times?

Did you suggest Asthma to the GP straightaway because the pharmacist advised you to before letting the GP do his examination based on the symptoms only?
DD might have a chest infection which has been overlooked due to the suggestion on Asthma which DD may not even have.
Does DD get chest pains after climbing stairs or walking certain distances?

You need to do 3 readings immediately after each other within seconds and take the middle reading.

She was stood, did a big sharp blow and looked to do it right (DH has asthma so familiar with the test)
First 2 readings 150, 3rd 165.

Does she get wheezing or shortness of breath?

There's this as a guide. Remember though that a peak flow can be lower if there's any kind of respiratory issue- cough, sore throat, chest infections, virus, not just asthma. And even with asthma depending on how well controlled it is it will vary (life long asthmatic here).

150 normal if she is approx 115cm in height and a healthy weight.

Also, worth noting hayfever for many started early this year. My husband , son and I (I'm the only asthmatic) have had an irritating cough since the start of March because of all the fields around us .

tantric I did suggest asthma but also tonsillitis and chest infection. She had penicillin 4 weeks ago, obviously didn't help her cough.
The GP isn't keen on removing her tonsils even though they are huge.
I think he wants to rule out asthma as the test is pretty conclusive. He said if the peak flow didn't improve with the inhaler, it would probably be a viral infection causing the cough which he has seen a lot of recently.
I hope that makes sense.

I do not remember my DD’s readings but they were definitely very low at first as she didn’t have the right technique. But they were also better after taking the blue inhaler and she was eventually diagnosed with asthma.

We were told to, for a week, do the peak flow then do a reading immediately after taking the blue inhaler and record to see if the reading was better. After a week of doing this, we did brown inhaler twice a day and recorded readings for two weeks (I think) based on this. For my DD the readings were clearly better with an inhaler and they eventually diagnosed asthma. This was after several bad chest infections though. At first they usually give a blue inhaler for when needed.

But... post-viral coughs can last a really long time. And as a pp said I hope they ruled out a chest infection?

Sorry cross post

Thanks for the chart Kanga. She is 128cm and I think 4 stone. Do you think its a bit low?
I will test her for the next few days and hopefully get a better idea.
Her dad suffers with asthma, hay-fever and allergies.

Ok keep an eye on her temperature etc if she gets hot and feverish it may well be from pharyngitis which will need antibiotics.

It may be that she needs something other than penicillin as an antibiotic if it comes to that or to get rid of a milder chest infection.
Penicillin doesn't work for everything on everyone.
Does her throat hurt? if so just sore?
If it does turn into pharyngitis it will be painful to the point that she will be in tears, permanently as it's boody painful.

Yes it does seem to be low for her height.

What's the peak flow after taking her blue inhaler? Does it improve at all? Watch her inhale making sure she exhales out first then fully inhales after pressing the inhaler. The spacer fortunately makes it all so much easier.

Thanks emmapeeler, I hoped it might be low due to technique.
She coughs a lot every time she exerts herself so the doctor suggested doing the peak flow reading after exercise and if the reading drops, use the blue inhaler and test again.
It sounds like we should know if it's asthma fairly quickly.

My ds always has a v low peak flow even when asthma is totally fine. In think he's just not good at the short blow. He's 13 now. I recognise the signs of him being asthmatic and he has regular check ups so peak flow is just one thing. If her oxygen sats are ok (assume doc did this) then she's probably ok.

Haven't used the inhaler yet tantric , just saw the GP this evening. Thanks for all your tips.
Her throat is sore. I look at it now and then with a torch and lollypop stick. She has one massive tonsil that pushes the dangly bit at the back of her throat over to the side. She complains her throat feels 'plain'.
I'll be monitoring her carefully for the next few days /weeks.
Thank you everybody

Like your DH, I have asthma, allergies and hay fever so it wasn’t surprising when DD had it. I did push for a proper diagnosis and brown inhaler on that basis. She takes it once in the morning and evening. Asthma is worrying for a parent, but you are doing the right thing with the peak flows and if they are low because of asthma then the inhalers will help. DD goes once a year to a lovely asthma nurse so we an get advice.

Good luck!

My DD also has a prescription of anti-histamine for general allergies which the GP said she could take every day if she wanted to.

My 7 year old can’t do peak flow some kids can’t and why didn’t your gp show you how to do them properly before you left?
I’m assuming you were shown how to use inhalers and given a plan for worsening if your child has an exacerbation?

My son has had asthma for quite a long time and doesn’t always wheeze when he’s unwell he also coughs so exacerbation take different forms but he can use his inhaler independently now (unless unwell obviously)

Asthma uk is a good resource for advice/information and they have nurses on call on the phOne during the week, I’ve found them very helpful - my own asthma nurse for my son is hopeless and told us utter nonsense (I’m also a paeds nurse) my son also takes seretide, citarazine (can’t spell soz) which helps with allergy/nasal congestion just and hay fever & Which mostly keeps him well until he gets a cold.

Hopefully you’ll get to the bottom of this, and it’s trial and error getting the correct combination of meds to prevent exacerbation.

My 6 year old DS had a persistent cough which was eventually diagnosed as asthma. The GP said at the time that the variation in readings across the day is more important/more of an indicator of asthma than the actual level. Having recorded the peak flow meter 3-4 times per day for a month she diagnosed asthma based on the chart we plotted it on. Now with one puff on the brown inhaler in the morning and at bedtime the cough is totally gone. He has never needs the blue inhaler

You need to do 3 readings immediately after each other within seconds and take the middle reading.

You're supposed to take the highest reading of the three.

OP - as another poster has suggested, the doctor should be looking to see (a) what range your daughter's PEFR is in (predicted value for her height & age would be approx 240 L/min, but being lower than that isn't in itself a problem), (b) how much it varies between morning and evening (> 15% variation is an indicator of asthma), and (c) how much it increases after inhalation of 200 µg of salbutamol (2 puffs of the blue inhaler). Don't worry about the absolute values: make sure you get an accurate set of measurments to take back to the doctor or asthma nurse.

It's important to see a good asthma nurse specialist regularly.

Many people who have had asthma for years do not inhale correctly from their blue or brown inhalers.

They should watch you inhale when you see them to make sure the technique is correct despite the fact you may believe it is being done correctly.
Most errors are not breathing out first, not clamping your teeth and mouth around the entrance properly, not breathing in fully whilst pressing down on the inhaler, not taking the inhaler away from your mouth too quickly which allows the medication to escape.

If you know for example you get asthma walking to school or work etc then you would use your blue inhaler before you walk out the door and not just when you feel symptoms like a tight chest. This puff will last for 4 hours.

If for a school child they then walk back home at 3pm for example they would puff before leaving school for their walk home to allow good airflow from their airway.
This is good asthma management.
If you are using the blue inhaler more than 3 times a week then you definitely need a brown inhaler too.
If your asthma is brought on only by cold weather for example then you wont really need the brown inhaler until the weather gets colder then you would use your brown inhaler as prescribed every evening and every morning till the weather gets warmer. You would still be using your blue inhaler.