Determining the reasons for poorly controlled asthma in an adolescent

### What you need to know A 15 year old girl with a history of mild asthma visits her GP. She has been waking at night coughing and has missed several days of school because of wheeze and chest tightness. Her first GCSE exam is three weeks away. Two years ago, at her last asthma review, her symptoms were well controlled with inhaled beclomethasone dipropionate 200 μg twice daily. Periods of worsening asthma are common in young people,1 and non-specialists may be the first port of call. Poor symptom control is a risk factor for acute asthma attacks and is associated with increased mortality.2 Assessing asthma can be more challenging than it might at first appear. Identifying psychosocial stressors and how they might affect adherence to treatment including following a self management plan, the perception of symptoms, as well as direct effects on bronchial hyperreactivity, can be key to helping the young person.3 This article offers an approach to a consultation with an adolescent with asthma symptoms related to psychosocial factors and dysfunctional breathing. Spend time with the young person to build rapport. This may be key to identifying their needs, priorities, and the underlying causes of their symptoms. Assess severity —A …