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Charlie

Charlie. Case study. Part 1: the story so far…. 18-month old infant with cough and wheeze and a history of eczema Family history of asthma and eczema On examination there is mild sub-costal recession, hyperinflation of the chest with a prominent sternum and widespread wheeze

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Charlie

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  1. Charlie Case study

  2. Part 1: the story so far… • 18-month old infant with cough and wheeze and a history of eczema • Family history of asthma and eczema • On examination there is mild sub-costal recession, hyperinflation of the chest with a prominent sternum and widespread wheeze • Evidence of eczema.

  3. Part 1: questions How do you eliminate most of the possible causes of Charlie’s symptoms? What questions do you ask about the family?

  4. Part 1: key point • Diagnose before treating

  5. Part 2: the story continues… • Diagnosed with asthma • Age 5 years, starting school, control lost • Symptomatic with inhaled corticosteroids 200mcg bd

  6. Part 2: questions What do you think is the appropriate next step for management of Charlie’s symptoms? Should Charlie be referred for specialist assessment?

  7. Part 2: key point • Add inhaled long-acting ß2 agonists rather than increasing dose of inhaled steroids (above 800mcg/day in adults and 400mcg/day in children) in children from 5 years onwards

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