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Asthma Scenarios
These assume knowledge of the British
Thoracic Society Guidelines
Joshua age 4
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
Joshua age 4
What is the likely diagnosis?

What would you say to the parents?

What treatment would you give?

What follow up will you arrange?

Michael age 16
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
On examination his peak flow is 400.
Michael age 16
What is going through your mind?

What questions will help you determine

what to do next?
Michael age 16
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

Explain how you might handle things from

Mrs Williams
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.
She is currently on regular salbutamol and
beclomethasone 200mcg 2 puffs bd
Discuss your therapeutic options
Mr Smith
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
Mr Smith
What is the likely diagnosis?
Discuss the tests likely to help you decide
whether to do as Mr Smith wishes.
What are the issues raised by this case?