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
