2a Asthma COPD Role Plays (adapted from The Complete CSA Casebook, written by Drs

Blount, Kirby-Blount and Moulton, 2017)

For each role play there is additional learning material found within the ‘Asthma & COPD
Role Plays’ ppt presentation

2a Asthma/COPD Role Plays: Number 1

Doctor’s Notes

Patient Peter Atkins

12 years old
Male

Booking notes ‘Coughing for months. Mum booked appointment’

PMH Eczema
Hayfever
Viral induced Wheeze

Current medications Oilatum cream prn

Previous medications Salbutamol MDI inhaler 1-2 puffs every 4-6 hourly for wheeze
Volumatic spacer for use with MDI inhaler
Loratadine 10mg od prn for hayfever

Allergies Not known

Consultations 3/12 ago. Mild eczema – emmolients encouraged

Household Rachel Atkins 40 years

Mark Atkins 42 years

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2a Asthma/COPD Role Plays: Number 1

Mum’s notes

Mum speaks first if a question is not directed to Peter

Mum starts by saying ‘Doctor, Peter keeps coughing every night and it’s been going on for
months’

Peter has had a dry cough for months, especially at night and it keeps you awake
He is not breathless and has no sputum or fever
He has not complained of pain
He is well and you have not heard him wheeze
Peter has had no other symptoms for months
Peter has not used his 9very old inhaler for months, since last winter

He was born around his due date and was always well. Immunisations are up to date.
No FH
Eczema is mild and controlled with Oilatum
No allergies
No pets
Only child
Parents both smoke but not in the house

You know Peter has viral wheeze after multiple doctors have said so
You are not worried but have brought him here today for antibiotics
Peter has not told you about his friend John or his worries about Asthma

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2a Day Asthma/COPD Role Plays: Number 1

Peter’s notes

Peter is quiet and requires encouragement from the doctor to speak

Mum starts by saying ‘Doctor, Peter keeps coughing every night and it’s been going on for
months’

You are ‘fine’

When you play football you feel wheezy and out of breath
Your friends can run around for longer
You have had a dry cough for months, especially at night
You are not breathless and have no sputum or fever
You are not in pain
You do not have an itchy nose at present
You recall that you used to use an inhaler
No allergies
No pets
Only child
Parents smoke but not in the house

If asked, you think the diagnosis is Asthma

Mention ‘John has asthma too’
John is your friend and is asked about John tell the doctor that John ‘went into hospital
because he couldn’t play football’ He was using his inhaler a lot and that day he was sat on
the football pitch with it.
You think you need the inhaler like John.
You don’t want to go to hospital
If asked what you understand about Asthma, say ‘John uses his inhaler before he plays
football’

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2a Asthma/COPD Role Plays: Number 1

Observer’s notes

If requested, the examination findings are:

Height 140
PEFR 270
Chest clear, no wheeze
HS normal
HR 80 reg, RR 17, Sats 98% o/a, Apyrexial

A good candidate will be able to:

Data gathering enquire about sob, wheeze and cough and identify triggers and
diurnal variation
enquire about symptoms of fever, pain,
enquire about PMH and FH atopy
obtain an adequate birth hx, PMH, DH and allergies
- enquire about previous use of inhaler, how often,
propose a focused respiratory examination with height, HR, oxygen
saturations, auscultation, PEFR

Clinical Management provide and explanation of diagnosis (asthma >viral induced wheeze)
in lay-mans’ terms
provide explanation of proposed management including inhalers
required, investigations (PEFR and inhaler use diary), follow up
(Asthma Nurse and management plan) and specific advice regarding
when to seek help if symptoms are worsening
check Mum and Peter’s understanding of management plan, safety
net and follow up

Interpersonal Skills Direct questioning to Peter, rather than his Mum

Take on board Peter’s and Mum’s ICE when proposing a management
plan

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2a Asthma/COPD Role Plays: Number 2

Doctor’s notes

Patient Mark Wright

55 years old
Male

Booking notes ‘Asthma review’

PMH Asthma
Bilateral conjunctivitis from welding 2009
DNA asthma clinic 2020
FB right eye from grinding 2008
BP 120/80 2009
BMI 27 2020

Medications Salbutamol MDI 2 puffs qds prn

Clenil modulate 100 2 puffs bd

Allergies None

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2a Asthma/COPD Role Plays: Number 2

Patient’s notes

‘I was told I needed an Asthma Review’

You received a note on your prescription asking you to come into the GPs for an asthma
review. You have booked an appointment with the doctor rather than the nurse, as she
does not work on your afternoon off.

Social History – You are married with two children who have left home, smoke 2 cigars a
week (your one delightful sin which you savour over a glass or port and will not give up),
you drink 20 units of alcohol. You work in the local bank (admin). Your hobby is classical car
restoration, and you are currently restoring a Triumph TR4a from 1966.

You have had asthma for 20 years and have come to live with it, although you know little
about it.

It may wake you up occasionally from sleep such that you need a puff of the ‘blue inhaler’
but you feel overall that things are not too bad.

If you exert yourself, you can get breathless, but you are unsure if that is just being unfit or
due to asthma!

You have a brown inhaler that you are meant to take twice a day but often forget the
evening dose and a blue inhaler that you have to use when you get wheezy (four x a week).

You use your puffer without a spacer – ‘just suck it up from the inhaler’ and have no idea
what a spacer is.

Ideas – you need more inhalers!

Concerns – another lecture on smoking
Expectations – repeat of inhalers & another lecture on smoking

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2a Asthma/COPD Role Plays: Number 2

Observer’s notes

If requested, the examination findings are:

Pulse & BP normal
PFR 450
Chest clear

A good candidate will be able to:

History taking Demonstrate an understanding of asthma

Identify symptoms indicating poor control
Identify inhaler ‘misuse’
Identify smoking status

Clinical management Explain asthma and concept of ‘preventers’ and ‘relievers’

Identify and explain suboptimal control
Provide appropriate inhaler advice- role of spacers, how to use
inhaled steroids
Provide advice regarding health promotion, smoking cessation,
exercises, immunisations

Interpersonal skills Identify and deal with ICE while maintaining good rapport
Accepts patient dissent re smoking
Non judgemental
Negotiate
Demonstrate good time keeping and good structure

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2a Asthma/COPD Role Plays: Number 3

Doctor’s notes

Patient Daisy Fitton

24 years
Female

PMH Asthma

Current medications Clenil 100 2 puffs bd

Salbutamol prn

Allergies No information

Consultation Last attended 9 months ago for asthma review with nurse
PEFR 450l/min

Investigations No information

Household No household members registered

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2a Asthma/COPD Role Plays: Number 3

Patient’s notes

You are a little distracted by your breathing

‘My Asthma isn’t very good’

You’ve had a cold and a sore throat for the past 2 days and you’ve become wheezy
You are not coughing any phlegm and have no pain but feel tight in the chest.
No fever
Your chest always feels like this and this time of year
You were admitted once a child but have had no ITU admissions
You have had 2 courses of steroids in the last 12/12
You use the clenil bd and usually use salbutamol 6 times a week, especially after hockey.
You don’t know your usual PEFR
You last took your salbutamol 1 hour ago

You are a solicitor

You live with your boyfriend
You have never smoked
All is well

You believe the weather has caused the exacerbation

You are not too concerned
You expect the doctor will give you steroids and antibiotics
You will follow the doctor’s advice regarding admission, stating ‘you are the doctor’.

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2a Asthma/COPD Role Plays: Number 3

Observer’s notes

If requested, the examination findings are:

RR 24, Sats 95%, HR 104, Temp 36.9
Vesicular breaths and wheeze throughout. Good AE R=L
PEFR 210

A good candidate will be able to:

Data Gathering: enquire about inhaler use, both when well and more recently
enquire about previous admissions including to ITU, previous courses
of steroids and the personalised asthma action plan
enquire about support at home or locally
enquire what the patient thinks has triggered this exacerbation and
what management she thinks is necessary on this occasion

Clinical management: explain that the PEFR and RR suggest a severe exacerbation of
asthma, caused by a viral infection
propose a safe management plan including immediate salbutamol
nebuliser and 40mg prednisolone, review in 10-20mins and decide
whether or not a hospital admission is required (how does the patient
feel about this?)
explain that antibiotics are not required as there is no evidence of
bacterial infection
explain that if she goes home, she will need to complete a course of
prednisolone and use her reliever/blue inhaler up to 10puffs 4 hourly.
If she needs to take it more frequently than that she will
suggest that when feeling better needs an asthma review with GP or
Asthma Nurse to review the ongoing use of blue inhaler and decide if
the preventer/brown inhaler needs to be increased
advise that if breathing is deteriorating further needs to contact
111/999

Interpersonal Skills: Identify and deal with ICE whilst maintaining rapport
Negotiate management plan
Demonstrate a safe management plan and good time keeping skills

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2a Asthma/COPD Role Plays: Number 4

Doctor’s Notes:

Patient Chao Lin

82 years
Male

Booking notes Respiratory Review

PMH COPD
Current smoker

Medications Salbutamol
Tiotropium

Allergies NKDA

Consultations COPD review 12/12 ago – no changes made.

Using Salbutamol on the hills.
Tiotropium daily.
Saturations 96%.
MRC dyspnoea scale- 2.
Weight 72kg

Documents Spirometry 1 year ago:

FEV1 = 48%
FVC = 80%
FEV1/FVC = 0.6
FEV1 following salbutamol = 52%

Household No known household contacts

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2a Asthma/COPD Role Plays: Number 4

Patient’s notes

Breathing initially fast when enters but this settles after being seated

‘Hello Doctor. I had a letter asking me to attend for a check-up’

You don’t like to bother the doctor.

Apart from your breathing you are well, and you have no significant PMH.
You are compliant with your tiotropium and use the salbutamol twice daily.
You have no allergies.
You remember your grandparents were heavy breathers.
You never knew your father and your mother died when you were small.
You believe you are 82 years old but aren’t sure.
Your breathing hasn’t been very good for the past 6/12.
You started wheezing about 3 years ago.
You wheeze when you walk to the shops and you’re ok in the home but occasionally wheeze
after having a shower.
You have no orthopnoea and sleep on two thin pillows.
You have no fluid collecting in the legs and have no cardiac symptoms.
When you grew up your grandparents used to light fires to keep you warm.
You had no siblings.
You had three infections last year and once you were in hospital overnight which was
frightening.

You moved to the UK when you were 36 years old and worked in the shipyards.
You live alone and find life tiring.
You walk to the local shop a couple of hundred yards away and stop for a rest midway.
You use a shopping trolley to wheel your food back to the house but this is getting harder.
You do not drive.
Your son owns the local garage in the next village and offers to help and sees you twice a
week.
You lost your wife to bowel cancer 3 years ago.
You feel quite lonely but shouldn’t complain.
Your mood is a little low, but you have no thoughts of wanting to end your life.
Your religion (Buddism) is important to you.
You continue to smoke and would like to stop.
The surgery is on the next-door street to your home so walking to your appointment is ok.
You have no problems within your bungalow.

You worry about infection and whether one day you will struggle with your breathing.
Is it likely you will die of not being able to breath?
You have no expectations from the consultation and will follow any advice the doctor gives
A preference would be to avoid any infection if at all possible.

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2a Asthma/COPD Role Plays: Number 4

Observer’s notes

If requested, the examination findings are:

Chest – Reduced AE and wheeze throughout.

No accessory muscle use.
Saturations 94%, HR 72 bpm, BP 130/70
HS normal
No leg oedema or raised JVP
Weight 72kg
PEFR 200l/min
No supraclavicular lymphadenopathy or clubbing

A good candidate will demonstrate their ability to:

Data gathering Establish the patient’s agenda and ICE

Adopt a holistic approach to this elderly gentleman’s health
Identify his exposure to smoke, pollutants, occupational dusts
Ascertain a comprehensive cardiorespiratory review
Explore mood, spirituality, preferred priorities of care
Ascertain impact of COPD on his ADLs
Propose a focused examination

Clinical Management Explain that the COPD has progressed since his last review
Explain the nature of COPD in lay-man’s terms
Offer rescue pack of abx/steroids
Offer health promotion strategies such as immunisations, stop
smoking service and referral to the pulmonary rehab team
Offer up-titration of medication
Acknowledge the importance of ACP and arrange follow up
Offer safety net

Interpersonal skills Adopt a holistic approach to this patient’s care

Demonstrate curiosity and empathy

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