Practice 10-Minute Consultation

Asthma unresponsive to simple treatment in a child

BMJ 2008; 336 doi: (Published 21 February 2008) Cite this as: BMJ 2008;336:447
  1. Niamh O’Carroll, clinical teaching fellow1,
  2. John Fitzsimons, specialist registrar in respiratory paediatrics2,
  3. Siobhán Carr, consultant in respiratory paediatrics2
  1. 1Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP
  2. 2Barts and the London Children’s Hospital, London E1 1BB
  1. Correspondence to: N O’Carroll n.ocarroll{at}
  • Accepted 5 April 2007

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

What issues you should cover

Assess control of wheeze, cough, nights disturbed, absence from school, and interference with play or exercise. Assess frequency of use of short acting β2 agonists and courses of oral steroids. Ask about emergency consultations or hospital attendances and possible triggers, especially smoking and common allergens such as dust mite, pet dander, and pollens, as well as viral infections, exercise, cold air, emotional upset, and non-steroidal anti-inflammatory drugs. Ask about school: can he use the inhalers with …

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