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Zak is a three and half year old boy with suspected Asthma. Over the last few months his symptoms of cough and wheeze have been well controlled on a low dose paediatric inhaled corticosteroid (ICS). However, his mother is concerned that over the last month his Salbutamol requirement has gone up to several times a week and he is having a night-time cough.

He does not attend nursery and has not had contact with any sick children. They have had the same family cat for 4 years now. He has no coryzal symptoms or fevers and is well otherwise.

On examination, Zak is speaking in full sentences, his respiratory rate is 25 and has a faint scattered expiratory wheeze. He cannot manage an adequate peak flow technique.

What is the most appropriate next step?

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