Foundation · Referral · Nursing
Poorly controlled asthma in a 7-year-old
This case practises: A specific request · Leaving out what the reader doesn't need
Writing task
Today's date: 21 November 2026. You are the practice nurse at Brookside Medical Practice. Write a letter to Mr Daniel Osei, Asthma Nurse Educator, Northgate Children's Respiratory Service, Northgate Health Centre, 5 Mill Road, Northgate, referring Leo for asthma education. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.
Case notes
In the test you get 5 minutes to read, then 40 minutes to write.
Patient details - Leo Fernandes, DOB 14/04/2019 (7 y.o.) - Attends with mother (Mrs Clara Fernandes) - Seen today 21/11/2026, Brookside Medical Practice Social background - Father works offshore, away 3 weeks at a time - Older sister (12) plays football for county team - Leo enjoys swimming twice a week - Year 3 at Northgate Primary; likes drawing Medical history - Born at 39 weeks; no neonatal problems - Asthma diagnosed age 4 - Mild eczema - emollients - Immunisations up to date Medications - Beclometasone 100 mcg MDI, 2 puffs BD (preventer) - Salbutamol 100 mcg MDI PRN (reliever) Presenting problem - Night cough 4 nights/week for 6 weeks - Using salbutamol daily - Missed 5 school days this term - 2 courses of oral prednisolone in past 6 months; ED visit 03/10/2026 for exacerbation Assessment today - Chest clear, SpO2 98% on air - Uses MDI without spacer; no breath-hold - Mother stops preventer when symptoms settle - unsure it is needed daily - No written asthma action plan - Peak flow not done (unable to perform) Plan - Refer to asthma nurse educator: inhaler technique with spacer, written asthma action plan, education for mother on daily preventer use - GP review in 4 weeks
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Model answer Try writing your own letter first
Mr Daniel Osei Asthma Nurse Educator Northgate Children's Respiratory Service Northgate Health Centre 5 Mill Road Northgate 21 November 2026 Dear Mr Osei, Re: Leo Fernandes, DOB 14/04/2019 I am writing to refer Leo, a 7-year-old boy with poorly controlled asthma, for training in inhaler technique with a spacer, a written asthma action plan and education for his mother on daily preventer use. For the past six weeks, Leo has had a night cough on four nights a week and has needed his salbutamol reliever every day. He has missed five school days this term. He has also required two courses of oral prednisolone in the past six months, including after an emergency department visit on 3 October. Leo's current medicines are beclometasone 100 mcg, two puffs twice daily, and salbutamol as required. Today his chest was clear and his oxygen saturation was 98% on air. However, he uses his inhaler without a spacer and does not hold his breath. In addition, his mother stops the preventer once his symptoms settle, as she is unsure whether he needs it every day. He does not have an asthma action plan. He will have a GP review in four weeks. Please do not hesitate to contact me if you require any further information. Yours sincerely, Practice Nurse Brookside Medical Practice
What the reader needs
- Poorly controlled asthma: night cough 4 nights a week for 6 weeks, daily reliever use
- Two courses of oral prednisolone in 6 months and an emergency visit on 3 October
- Uses his inhaler without a spacer and does not hold his breath
- Mother stops the preventer when symptoms settle
- Request: inhaler technique with a spacer, a written asthma action plan, and education for the mother
- Current medicines: beclometasone preventer and salbutamol reliever
Details to leave out
- Father works offshore
- Sister plays football
- Swimming
- School year and drawing
- Birth history
- Eczema
- Immunisations
- Age at diagnosis
One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.