Take more history

You ask some more questions and listen to Mr and Mrs Horner as they describe Jack’s breathing problems. First you ask a bit more about his asthma. 

At about 14 months of age he developed a cough, particularly at night. The GP at first wondered if it was a chest infection, but it didn’t get better with antibiotics. He then wondered if it might be asthma and started Jack on salbutamol using a plastic canister, which they use with a mask to help Jack breathe it in. The GP told them that there is no specifice test for asthma, so they are not sure if this is the problem.

The parents have continued to use the inhaler and it seems to improve his sleep and cough at night.

You ask about risk factors for breathing problems, and find that the family have two cats and the mother smokes, although she is switching to vapes as she is trying to stop smoking altogether. Jack’s dad has eczema and had asthma when he was a child.

You find that he started crawling at 9 months and walking at 12 months. He is very adventurous and often getting into dangerous situations or stuck on the stairs. He investigates all his toys by chewing them and is particularly fond of his brother’s toys.

You ask more about the current episode.

The breathing problems came on fairly rapidly – while he was playing with his brother’s Lego® on the floor. He developed a dry tickly cough and later appeared to be having breathing problems. His parents thought it was probably asthma so tried his inhaler. However this did not much difference to his breathing.

What would you like to do next?