Asthma Scenarios n These assume knowledge of the British Thoracic Society Guidelines
Joshua age 4 n Joshua is 4 years old. He has had a persistant cough for weeks that wakes him at night. Every cold goes to his chest This is the fifth consultation for cough in the last year. Only once has a wheeze been documented.
Joshua age 4 n What is the likely diagnosis? n What would you say to the parents? n What treatment would you give? n What follow up will you arrange?
Michael age 16 n Michael is tall for 16 and stands at just over six foot.He has been known to have had asthma for many years. You have called him in for a routine medication review. You note that he is using 2 salbutamol inhalers each month. He denies any problems with his asthma. n On examination his peak flow is 400.
Michael age 16 n What is going through your mind? n What questions will help you determine what to do next?
Michael age 16 n He admits to 2-3 disturbed nights a week. He avoids sport as he is unfit - he gets short of breath. He is reluctant to use inhaled steroids as he wants to join the RAF n Explain how you might handle things from here?
Mrs Williams n Sandra is 60 years old and has had asthma for 4 years. She has attended today as she has a cough, is short of breath and getting disturbed nights. n She is currently on regular salbutamol and beclomethasone 200mcg 2 puffs bd n Discuss your therapeutic options
Mr Smith n A lifelong heavy smoker and asthmatic, the seventy year old Mr Smith is wheezing most days and always is short of breath. He is on regular combivent, beclomethasone 200mcg bd and intermittant salbutamol. He has the offer of a cheap nebuliser and is asking if you will provide the necessary prescriptions
Mr Smith n What is the likely diagnosis? n Discuss the tests likely to help you decide whether to do as Mr Smith wishes. n What are the issues raised by this case?