The days and weeks following a bad asthma attack are a particularly vulnerable time. Your lungs will be quite irritable and twitchy and may take some time to recover fully. Monitoring your asthma using the Asthma Assistant Application can help both you and your doctor assess any improvement in your condition with greater accuracy. This can give a clearer idea as to if and when you are well enough to decrease your medications.

Case Study

Name: Andy
Age: 20 years

Background
Andy takes a daily preventer inhaler and is usually very well. Last month he had a bad asthma attack and had to go to the casualty department of his local hospital. He was studying for university exams and was under a lot of pressure. The attack really scared him. He had never bothered too much about his asthma as he was usually "O.K." When Andy visits the asthma clinic 3 weeks after his attack he says he feels much better. He is keen to cut down his inhaled preventer and has come for the nurse’s advice. He brings his reports from the Asthma Assistant with him.

Monitoring with the Asthma Assistant
Andy monitored his asthma using the 'Basic Daily Card'. Here we will look at the peak flow section of Andy’s 'Weekly Comparison Report' for the last two weeks in the run up to his asthma clinic appointment.



The 'Peak Flow Percentage Best Chart' shows that in Week 2, Andy’s peak flow readings are all in his yellow zone. This is confirmed by the zone activity calculation in the table below the chart: Andy’s morning and evening peak flow were both 100% of the time in his yellow zone. As both his evening and morning readings are low, his average diurnal variation (Avg. Diurnal Variation) for Week 2 is 9%, which is normal. This is an example of how your peak flow can be low, which is a sign of poorly controlled or worsening asthma, but your diurnal variation might be normal.

In Week 3, all Andy’s morning peak flow readings are in his yellow zone (Zone Activity: yellow=100%); most of his evening peak flow readings are in his green zone (Zone Activity: green=86%). However, his average diurnal variation (Avg. Diurnal Variation) is 29% in Week 3: this is a definite sign of poorly controlled asthma. Additionally, the average of the morning readings, shown under 'Peak Flow Graph Data: Average', is lower in Week 3 at 363 l/min compared to 390 l/min in Week 2.

Summary
This 'Weekly Comparison Report' can provide an excellent overview of changes in your asthma from one week to the next. A quick glance at this section of the report would tell Andy’s nurse that he is definitely not well enough, at this time, to halve his inhaled steroid preventer safely. This report section demonstrates signs of uncontrolled asthma. It is not uncommon for people to feel much better and their symptoms to improve dramatically after an attack before their lungs recover fully (as reflected by their peak flow readings); this is a perfect example of such a situation.