Intro:

Hello I am Dr I am here to talk about your little one today and I will
need to to ask few questions about his condition.
As the name of your little one? And try to address the baby by name.

Asthma History taking

History of presenting complaint: Explore (ODIPARA)

Onset, Duration, Intensity or severity (How is it affecting your baby? Can he play
normally? Is sleep and schooling disturbed), progression or Frequency, Aggravating,
Relieving factors, Associated symptoms (cough, wheeze, cyanosis etc.), Ask
Timing- Can you remember any particular time of year seasonal/ diurnal variation. If
Cough-Character of the cough.
Specific questions to Rule/out differentials:
Asthma: Coughing thats constant , intermittent seems to link with
physical activity, any whistling sounds when child exhales and short of
breath.
Cystic Fibrosis: How is your child's growth and development-Slow in CF,
Productive cough, repeated chest infections since childhood, how is
stools-Fatty n foul smelling in CF.
Pneumonia: cough with tachypnea and grunting sounds may be chest wall
retractions. And fever.
Tuberculosis: blood in sputum, any lumps in the neck, sweating, malaise,
fever.
Or we can ask about constitutional symptoms Eg. Fever, tiredness, inactive,
sweating etc. Once after asking for associated symptoms.

Past Medical history:

Any similar episodes.
BIRD
Birth, immunization, Record book & Development history.
Family History: Asthma, cystic fibrosis, H/o-Atopy: Hay fever, rhinitis, eczema .
Does anyone at home smokes? Any pets at home?

Social History:

Personal, housing- old or new building, is your home warm & dry old carpets , about
living conditions ( any stresses?

Counselling or communication for Asthma

Hello Mrs. X , I am Dr. Y. Looking after your little one.

As you know that little JOHN came to us with difficulty breathing , after running
some tests we found that he has a condition called ASTHMA. Do not worry Now he
is doing well after being treated with certain medication to relieve his condition.
Do you know about Asthma? Or what do you know about Asthma?
It is a condition where the airways become narrower when they are exposed to
some stimulus such as cold and flu , dust , exercise, smoke or infection and
sometimes the cause is not known. Due to narrowing of the airways the child has
wheeze and breathing difficulty. But Its good that you came to us from here we will
decide and talk about his management plan is that OK for you?
Do you have any questions ?
If any questions- need to answer.
Else, tell further.
Treatment Goal is to eliminate symptoms and reduce the frequency of asthma
attack.
Treatment Plan include:
1.

Medication- Inhalers relievers for short term relief which opens the
airway ( breathing tubes) allowing air to flow thru them. If need to explain
about inhalers then you need to add : preventer inhalers: treat the
inflammation and reduce swelling again opening the air tubes and reduces
sensitivity to asthma triggers, and the third type is symptom controller
inhalers: these relaxes the muscles in the airways for up to 12 hrs (for long
term relief in severe cases when sleep is disturbed). Steroid is usually used
for short term until the frequency of attack decreases. State some of the side
effects- like gastritis, weakening of bone ( only in prolonged usage), but if
weigh benefits verses risks then use of steroid is recommended for treating
Asthma, and frequent checkups will keep the side effects at bay.

(1. Inhaler use instructions: I am here to talk to you about this device
which we call Inhaler.
Are you familiar with it? Have you used it before?
Well, this inhaler delivers a medication called Salbutamol which opens the
breathing tubes of the airway and so breathing becomes better.
Now, how to use it?
First of all, we need to shake it just before we use.
Then, breathe out fully away from the inhaler and open the cap and put the
mouthpiece in your mouth and hold it firmly between your lips. Just before
you breathe in you need to press the top of the inhaler so that the medicine
can be released.
Once you breath in, you need to hold on your breath for at least 10 seconds
or as long as possible.
Now let me do it in front of you.
Now can you please do it in front of me so I can make sure you are doing it
correctly? Once you have used one time you can repeat it after one minute).
(2.The spacer use instructions: Again ask if the patient is familiar with it?
Okay, as you see, two halves which fit into each other to form this plastic
conical chamber.
It has a slot on one side where the inhaler fits, the other end has a
mouthpiece to breathe in, which has a valve that opens during breath in and
closes during breath out. All what you need to do is follow these steps:
First of all , assemble the spacer ( show the patient and say- just like
this), then shake the inhaler and remove the cap, then insert it in the
slot .
After you have breath out slowly as much as you can, hold the spacer
horizontally, close your lips firmly around the mouthpiece, press the
inhaler once and breath in slowly and deeply. Hold your breath for 5-10
Sec or as much as comfortable.
Remove the spacer from your mouth and breathe out. You can repeat
this 3-7 times before you press the inhaler again to take another dose.
Asks the patient Is everything clear? Do you want me to do it in front of you
or you want to do it yourself?
Now, just a few words about how to clean the device:
Just rinse it out with tap water, do not use detergents, after that leave it to
dry in the air and do not wipe it. Once a week is enough.
Finally, lets talk about the good and bad aspects of it:
First, the good side : Its easy to use, improves delivery of medicine to the
lungs and makes the possibility of mouth infection when using steroids with
Candida much less.

The only bad aspect is that, it is large in size as you see.

Do you have any questions?
Thank the patient for co-operation.
And also about SPACER : we have to demonstrate it .( Page -295 Plab London
book).

2. Environmental management: asthma attack can occur due to number of

triggers like- stress, exercise, smog, allergens, dust and even common cold,
so have to take precautions. Use of reliever inhalers ( blue) before any
stressful activity, or exercise.

3. Monitoring: for better symptom control its advisable to keep a record book
and record once a day reading of a device k/n as peak flow meter .
Instructions to use Peak Flow Meter: Well, first let me tell you why we use
it. It is to monitor the progress and response to treatment. As you see,
this is a very simple plastic device, all what you need to do is to follow
these steps in using it:

First of all, stand up if possible, and check the meter needle

(marker) is set to zero.
Have a full inspiration ( breath in slowly and as much as possible)
and place the mouthpiece firmly in your mouth and blow as HARD
and Fast as possible.
Do not forget you are holding it from its sides so that the meter
needle Marker-can move freely and it is horizontal.
Look at the reading, reset the marker to zero and start again.
Do this 3 times and record the highest peak flow reading of your
chart or your booklet. Do this twice a day ( morning and evening).
The chart is made according to age, sex, and height so make sure
you plot the results in the right place.
Now, could you please do it in front of me and I will help you where
exactly to put the results Thanks, I want to see you in a couple of
weeks time, Is that okay?
Thanks for your co-operation.

Then

at last Lifestyle changes:

Bracelet or card.
Inform school
Cats and dogs can make asthma worse.
Keep carpets clean.
Early treatment of chest infections.
Acute attacks: call Emergency and meanwhile, give 2 puffs from blue
inhaler if no relief repeat as it will keep the airway open until
ambulance arrives.

Then at last say if you have any questions you can plz ask. Or else you can
call us anytime we would be happy to explain. Pamphlets for reading. Thanks