Asthma review — uncontrolled symptoms

PLAB 2 & PRES 3 · respiratory · easy · 8 minutes

Candidate brief

You are a doctor in a GP practice. Ms Sarah Khan, 29, has booked an asthma review because her symptoms have become more frequent during the past 2 months. Assess her asthma control, identify possible reasons for poor control and agree an appropriate management plan. No physical examination is required, but verbalise any assessments you would perform.

What examiners look for

Uncontrolled asthma is not managed by automatically increasing medication. First confirm that the patient is stable, then assess symptoms, reliever use, exacerbations, adherence, inhaler technique, triggers, comorbidities and whether the diagnosis remains secure. Frequent SABA use is a warning sign. Do not prescribe SABA without inhaled corticosteroid-containing treatment. For UK practice, NICE NG245 recommends considering low-dose MART for people aged 12 and over whose asthma is uncontrolled on regular low-dose ICS plus SABA, after correcting adherence and technique. Only an appropriate licensed ICS/formoterol inhaler can be used for AIR or MART. Not every ICS/LABA combination provides rapid symptom relief. Provide a written personalised asthma action plan, correct inhaler technique, explain when urgent help is required and reassess 8 to 12 weeks after changing treatment. Irish PRES management should follow current Irish and local asthma prescribing pathways rather than automatically copying the UK treatment sequence.

Guideline references

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