GP's note (UK)

Discussed in a Telephone Consultation Consultation with mother (primary carer) of patient Follow-up call regarding ongoing asthma management in a 10-year-old child, with concerns about recent increase in night-time coughing and wheezing. Presented with: - Ongoing cough and wheeze over past 2 weeks, particularly at night. - Mild breathlessness during PE at school. - Past history of asthma diagnosed at age 6; no previous hospital admissions. - Current medication: Salbutamol inhaler PRN; beclometasone inhaler twice daily. - Existing care plan reviewed at last appointment — mother reports compliance with preventer inhaler, but salbutamol use increased to 3–4 times daily. - No recent changes at home; no known allergen exposures. - No prior surgeries. - No known drug allergies. Data and Past History: - Examination findings: Not applicable (telephone consultation) - Expectations: Mother hoped to get advice on adjusting medications and whether an urgent in-person review is required. - Vital signs: Not measured (telephone) - Investigations with results: None performed today - Patient's thoughts and expectations: Mother asked if inhaler dose could be increased and whether child can continue PE at school - Doctor explanation and answer: GP explained inhaler technique may need review and that short-term step-up therapy may help Management Plan Including Advice: 1. Asthma control deterioration - Asthma exacerbation (mild–moderate, likely viral trigger) - Plan: Continue beclometasone inhaler twice daily; increase dose to 200 mcg BD for 2 weeks. Continue salbutamol PRN; aim to reduce frequency as symptoms improve. Review inhaler technique in person within 1 week. - Advice: Monitor for signs of worsening (difficulty speaking, persistent wheeze after salbutamol, lethargy). Attend ED if symptoms escalate. - Relevant actions: Book face-to-face asthma review. Provide updated asthma action plan via email. 2. School participation concerns - Exercise-induced bronchospasm risk during exacerbation -- Expectations: Reduce risk of asthma symptoms during school activities - Plan: PE to be limited until symptoms controlled; short warm-up and salbutamol 15 min prior to activity if needed - Advice: Inform school nurse and teachers about current exacerbation and medication adjustments Mother confirmed understanding of medication changes, signs of deterioration, and follow-up plan. Other Problems (if any): - None discussed