Intended for healthcare professionals

Practice 10-Minute Consultation

Determining the reasons for poorly controlled asthma in an adolescent

BMJ 2019; 364 doi: (Published 21 January 2019) Cite this as: BMJ 2019;364:l75
  1. Gary James Connett, consultant respiratory paediatrician1,
  2. Lucy Anne Connett, student nurse2,
  3. Mike Thomas, professor of primary care research3
  1. 1Southampton Childrens Hospital, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
  2. 2Paediatric Nursing, London South Bank University School of Health and Social Care, London SE1 0AA, UK
  3. 3Depart of Medicine, University of Southampton, Southampton SO17 1BJ, UK
  1. Correspondence to: Gary Connett gary.connett{at}

What you need to know

  • Dysfunctional breathing, either as a result of induced laryngeal obstruction or a breathing pattern disorder, can cause treatment resistant wheeze in adolescents who also have asthma

  • Both severe asthma and dysfunctional breathing are associated with stress, anxiety, and depression

  • Those affected can be helped by explaining how psychosocial stressors can cause symptoms, how breathing can be out of kilter with the body’s needs, and how symptoms can be improved by breathing retraining exercises

A 15 year old girl with a history of mild asthma visits her GP. She has been waking at night coughing and has missed several days of school because of wheeze and chest tightness. Her first GCSE exam is three weeks away. Two years ago, at her last asthma review, her symptoms were well controlled with inhaled beclomethasone dipropionate 200 μg twice daily.

Periods of worsening asthma are common in young people,1 and non-specialists may be the first port of call. Poor symptom control is a risk factor for acute asthma attacks and is associated with increased mortality.2 Assessing asthma can be more challenging than it might at first appear. Identifying psychosocial stressors and how they might affect adherence to treatment including following a self management plan, the perception of symptoms, as well as direct effects on bronchial hyperreactivity, can be key to helping the young person.3 This article offers an approach to a consultation with an adolescent with asthma symptoms related to psychosocial factors and dysfunctional breathing.

What you should cover

Spend time with the young person to build rapport. This may be key to identifying their needs, priorities, and the underlying causes of their symptoms.

Assess severity—A …

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