An 8-year-old male patient (weight: 26kg) is brought to the Emergency Department by his parents due to unresolved difficulty breathing. His parents state he has had fever (up to 40°C), cough, runny nose and sputum sound for four days. The patient saw his pediatrician two days ago and was prescribed amoxicillin 500mg PO TDS. The patient has had no appetite and is not able to eat much.

Past Medical History: asthma, eczema, 

Medications prior to admission: Seretide (salmeterol/fluticasone) and montelukast 

Social history: Elementary student. Father is a smoker

Vital Signs: BP 100/60mmHg, HR 130/min, RR 50/min, T 38.8°C (ear) SaO2 95% (on 4L O2) 

Physical Examination: Alert and orientated. The patient has some in sucking and is barely able to speak. Positive for hyperinflated chest.

a)   The physician diagnose the patient as moderate asthma attack +/- infection. What initial drug regimen(s) would you recommend? State the details of each medication along with the duration. Justify your response.

(10 marks)

b)   One week later the patient is feeling better and is about to be discharged home.  Are there any recommendations you can consider to improve the patient’s asthma control?

(5 marks)