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Penelope is a seven year old girl who has been brought to see you by her mother as she is concerned about her Asthma control. Penelope was diagnosed with Asthma one year ago and is currently prescribed Salbutamol for use as required and a low dose inhaled corticosteroid (ICS) Beclomethasone dipropionate inhaler. Penelope’s mum explained that over the last six weeks Penelope has been needing to use her Salbutamol inhaler every other day. She is not aware of any potential trigger for this and she has been otherwise well in herself.

On examination, Penelope is speaking in full sentences and not using any accessory muscles, her respiratory rate is 16, oxygen saturations are 99% and on auscultation you note a faint polyphonic expiratory wheeze.

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