Clinical Scenarios

Clinical Scenario



By the end of Family Medicine Clerkship, students will be able to:

1. Establish an accurate diagnosis of asthma through a focused history and physical exam
a. Including family, occupational and environmental history
b. Including differentiating non-asthma causes of wheezing

2. Explain underlying pathophysiology of asthma to patients and/or family members
a. In relation to acute & recurrent episodes and prophylaxis principles
b. In relation to mechanism of action for relevant meds
c. In relation to red flags of impending asthma crisis

3. Assess asthma control at follow-up.  Identify modifiable triggers for patients.

4. Describe the different medication delivery methods (and relevant compliance / educational issues).

5. Describe major medication categories
a. Including mechanism of drug action, particularly SABA and ICS
b. Benefits, risks, limitations
c. Use patterns, compliance, device use

6. Propose a management plan for patients with acute exacerbations.

Clinical Cards


Recommended Resources Addressing the Objectives

Childhood asthma: a guide for pediatric emergency medicine providers (23 pages) Detailed, thorough, very good approach to first-time wheeze as well as asthma. Pediatric focus, but concepts translatable to adults.

Objectives covered: 1ab, 2ab, 4, 5abc, 6
Kline-Krammes S, Patel NH, Robinson S. Childhood asthma: a guide for pediatric emergency medicine providers. Emerg Med Clin North Am 2013 Aug;31(3):705-732.

Calgary Guide articles on the pathophysiology behind the clinical and investigation findings of asthma

Objectives covered: 2ac

Childhood Asthma: Diagnosis and Treatment (page 6 only) Very comprehensive; use this to learn how to monitor and followup asthma patients. If desired, this paper also provides additional information about asthma phenotypes in children, and how to predict if asthma in the pre-school child will be transient or permanent. The tables are particularly useful. Too much detail in Management sections.

Objectives covered: 1ab, 3, 5
an Aalderen WM. Childhood asthma: diagnosis and treatment. Scientifica (Cairo) 2012;2012:674204.

Foundational Knowledge

As well as entire section on obstructive lung disease:

Additional Resources

Comprehensive overview of pathogenesis, diagnosis, and management of asthma (20 pages) Great resource, more in-depth on pathophysiology, but multiple conflicts of interest (page 22)

Objectives covered: 1ab, 2a, 3, 4, 5bc, 6
Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Gotz M, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008 Jan;63(1):5-34.

Top 10 causes of dyspnea in family medicine, plus clinical pearls (1 page)

Objectives covered: 1b
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: dyspnea. Can Fam Physician 2007 Aug;53(8):1333.

Managing acute asthma exacerbations (Am fam physician – 8 pages) Handy, quick reference for recalling what to do to treat an acute asthma exacerbation in the ER.

Objectives covered: 6
Pollart SM, Compton RM, Elward KS. Management of acute asthma exacerbations. Am Fam Physician 2011 Jul 1;84(1):40-47.

Brief PubMed Fact sheet on medications for chronic asthma (uses lay language; short, easy read)

Objectives covered: 4, 5ab
U.S. National Library of Medicine. Fact sheet: Medication for people with chronic asthma. 2012; Available at: Accessed June/5, 2014.

Patient Information

The asthma action plan (2 pages, in both English and French)
Asthma Society of Canada. Asthma Action Plan. 2014; Available at: Accessed June/5, 2014.

Respiratory inhalers chart (1 page) – clarifies the type and color of different inhalers, includes brand and generic names
GlaxoSmithKline Inc. Respiratory Inhaler Identification Chart. 2005; Available at: Accessed June/5, 2014.