The Complete SCA Package.

Good use of the RCP 3 questions to establish uncontrolled asthma. SABA frequency, night symptoms, and activity limitation were all covered. Preventer adherence was explored and the walk-in episode was picked up from the history. Inhaler technique was mentioned but not examined in enough detail to assess what the actual fault was. Occupational history was not asked: the candidate established the patient works from home but did not ask specifically whether symptoms relate to the working environment, which is a standard question in adult asthma.

Appropriate step-up from ICS alone to ICS/LABA combination. Choice of Fostair and explanation of MART was accurate. Peak flow was measured. Spacer was recommended and referral to the asthma nurse was made. The written asthma action plan was issued but the candidate did not explain the green, amber, and red zones in a way that would enable the patient to use it independently. Safety-netting around acute episodes was present but did not include guidance on what to do in the first 24 hours of an upper respiratory infection, which is when this patient is most at risk.

The steroid concern was picked up and addressed clearly, and the patient was visibly reassured. ICE was explored. The candidate made a good observation that the steroid concern likely contributed to non-adherence. However, when the patient expressed that she missed yoga, the opportunity to build on this as a motivating goal was passed over quickly. The consultation was well-structured and the patient left informed. Checking the patient's understanding of the action plan at the end would have strengthened the closing.