Abstract
The parents of a 3-year old boy are anxious about their son who has recurring episodes of wheezing. They are frustrated that no one seems to be able to give them answers to their questions and would like a referral to a specialist. Does their son have asthma and what is the prognosis; how can the recurrent wheezing be managed and can the risk of asthma be reduced; are there lifestyle changes that could improve the environment and avoid triggers? Communication and support from the family practice team were essential. Listening to the parents’ concerns, explaining the diagnostic uncertainty, being realistic about what drug treatments could achieve, and providing practical advice on inhaler use and trigger avoidance reassured the parents that there was a strategy for managing their son’s wheeze. The specialist referral was postponed.
Highlights
● The parents of a 3 year old boy have come to see their family doctor about their son whose recurrent episodes of wheeze and respiratory symptoms are causing concern
A clinical case, such as this 3-year old boy with recurrent wheeze, raises many questions that need to be explored in order to address parental concerns and manage the child’s condition
With the exception of respiratory syncytial virus (RSV) in infants hospitalised with bronchiolitis, human rhinovirus (HRV) is by far the most common virus isolated in children over 12 months.[10]
Summary
● The parents of a 3 year old boy have come to see their family doctor about their son whose recurrent episodes of wheeze and respiratory symptoms are causing concern. They are frustrated that no-one seems able to give them a clear diagnosis, and worried because the treatment they have been given is not controlling his symptoms. ● Looking back through the records, the first episode of wheeze was at the age of 6 months This was diagnosed as bronchiolitis and resulted in a brief admission. A host of reasons may underpin the parent’s request Is their concern that the wheezy episodes are harmful? Is their concern that the wheezy episodes are harmful? Are they unable to sleep because the child is disturbed at night? Is it the lack of a clear diagnosis and uncertainty about the boy’s long-term prognosis that is causing the worry? Do the parents want advice on avoiding triggers or information on what to do when the wheezing recurs, or is the main focus of this consultation the (perceived) additional value of a referral to a specialist? Or all of these?
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