GP CCE Cases · respiratory-health
Adult asthma uncontrolled on reliever alone — CCE clinical encounter
CCE-style clinical encounter: a 34-year-old office worker with frequent reliever use, no preventer, and an unaddressed inhaler technique problem. The candidate must convert the consultation from script-renewal to structured asthma review, initiate anti-inflammatory reliever therapy, and safety-net.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 34-year-old office worker attends for 'another puffer script'. Dispensing records show five salbutamol inhalers in twelve months. She wheezes climbing stairs at work twice a week, wakes coughing about monthly, has never used a preventer, cannot recall ever being shown inhaler technique, and smokes ten cigarettes a day. She is worried an inhaler 'won't suit her' because her mother hated hers.
Objectives
- Reframe a script-renewal visit as a structured asthma review without alienating the patient. [1]
- Elicit the control picture (frequency of symptoms, night waking, reliever frequency) and the dispensing-record signal. [4]
- Explain why SABA-alone is no longer acceptable and initiate ICS-formoterol as-needed therapy with shared decision-making. [2]
- Demonstrate inhaler technique teaching and address the mother-inhaler belief. [4]
- Address smoking as a modifiable risk factor and safety-net appropriately. [5]
References5ShowHide
- [1]Levy ML, Bacharier LB, Bateman E, et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update NPJ primary care respiratory medicine, 2023.PMID 36754956
- [2]Reddel HK, Bacharier LB, Bateman ED, et al. Global Initiative for Asthma Strategy 2021. Executive Summary and Rationale for Key Changes Archivos de bronconeumologia, 2022.PMID 35245179
- [3]Beasley R, Holliday M, Reddel HK, et al. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma The New England journal of medicine, 2019.PMID 31112386
- [4]Reddel HK, Ampon MR, Poulos LM, et al. Worsening Asthma Outcomes in Australian Adults: A Comparison of Stratified Sample Surveys in 2012 and 2021 The Medical journal of Australia, 2026.PMID 42338170
- [5]Koppelman GH, Pino-Yanes M, Melén E, et al. Genetic and environmental risk factors for asthma: towards prevention The Lancet. Respiratory medicine, 2025.PMID 41038211