Asthma unresponsive to simple treatment in a child

doi:10.1136/bmj.39364.672940.47

BMJ 2008;336:447 (23 February), doi:10.1136/bmj.39364.672940.47

Practice

10-Minute Consultation

Asthma unresponsive to simple treatment in a child

Niamh O’Carroll, clinical teaching fellow¹, John Fitzsimons, specialist registrar in respiratory paediatrics², Siobhán Carr, consultant in respiratory paediatrics²

¹ Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP, ² Barts and the London Children’s Hospital, London E1 1BB

Correspondence to: N O’Carroll n.ocarroll@imperial.ac.uk

The first 150 words of the full text of this article appear below.

A 7 year old boy with recurrent wheeze was diagnosed with asthmasix months ago. He was started on two metered dose inhalers:a short acting β₂ agonist, as required, and an inhaledcorticosteroid 100 µg (beclometasone diproprionate equivalent)twice daily. When his symptoms continued his steroid inhalerwas increased to 200 µg twice daily, but he presents tothe surgery with regular wheeze.

Assess control of wheeze, cough, nights disturbed, absence fromschool, and interference with play or exercise. Assess frequencyof use of short acting β₂ agonists and courses of oralsteroids. Ask about emergency consultations or hospital attendancesand possible triggers, especially smoking and common allergenssuch as dust mite, pet dander, and pollens, as well as viralinfections, exercise, cold air, emotional upset, and non-steroidalanti-inflammatory drugs. Ask about school: can he use the inhalerswith the spacer device, and can he take his β₂agonist. . . [Full text of this article]