Explaining a child's asthma action plan to a parent
PLAB 2 & PRES 3 · paediatrics · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Lily Price, aged 7, was diagnosed with asthma six months ago. She takes a preventer inhaler (beclometasone) twice a day through a spacer, and a blue salbutamol reliever inhaler when needed. Her mother, Mrs Hannah Price, has brought her for an asthma review. Lily is well today. Please go through Lily's personalised written asthma action plan with her mother, check her understanding of the inhalers, and address her concerns.
What examiners look for
An action plan consultation is a rehearsal, not a lecture. The parent must leave able to perform the 2 a.m. version of the plan, half-asleep and frightened — which is why the teach-back ("talk me through tonight, if…") is the highest-value minute in the station. Start from the parent's frightening night, not from the leaflet. Her story contains every teaching point the plan exists for: recognising deterioration, how much reliever is allowed, when waiting becomes dangerous, and why the surgery should hear about it afterwards. Preventer logic is counter-intuitive and must be spelled out: the brown inhaler only works because it is taken on the well days. "Fine without it" is the disease being controlled, not the medicine being unnecessary — an analogy (like locking the door before the burglar, not after) helps it stick. Give the emergency drill as numbers, not vibes. One puff every 30 to 60 seconds through the spacer, up to ten puffs; no improvement, worsening, or no inhaler — 999. Parents in a panic do not improvise safely; they repeat what they were told, so tell them exactly. The growth question deserves the real numbers, kindly delivered: minimal effect from inhaled doses, growth monitored, and the counterfactual stated — uncontrolled asthma and repeated oral steroids are what actually threaten growth and schooling. Asthma plans die in school bags. The plan is not finished until copies live where the child lives: home, school (with a spare inhaler and staff who know where it is), and the grandparent's house with the cat. Logistics is clinical care in paediatrics. Credit before correction, always. She gave reliever, watched, gave more, and got her child through the night; the gaps were knowledge gaps the system left her with. A parent who feels blamed stops telling you the truth about adherence — and adherence honesty is what keeps this child safe.
Guideline references
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