Consultation

Do you know how and when to use your inhaler?

Have you called an ambulance or had emergency treatment for breathing problems in the 12 months?

Do you use your inhaler more than 3-4 times a day over the course of a week?

Has your Asthma been checked or monitored by a GP, pharmacist or Asthma nurse within the last 12 months?

Have you been prescribed Ventolin (Salbutamol) in the last 12 months?

Are you in control of your asthma and its triggers?

Do you have an allergy (hypersensitivity) to any asthma inhaler or have had any kind of reaction to any king of asthma inhaler before?

Are you pregnant or breast feeding or intending to become pregnant or start breast feeding within the next 6 months?
Have you been diagnosed with any of the following?
• Overactive thyroid gland
• History of heart problems such as an irregular or fast heartbeat or angina
• High blood pressure
• Any serious medical condition which may require immediate hospitalisation

Are you taking any of the following medications?
• Medicines for an irregular or fast heartbeat
• Medicines for your asthma (apart from your existing inhaler) such as oral asthma tablets
• Xanthine derivatives (such as theophylline) or steroids to treat asthma
• Water tablets (diuretics), sometimes used to treat high blood pressure or a heart condition

Do you understand that you must seek medical attention if your asthma symptoms do not improve within 1 hour of using your inhaler?

Do you agree to the following?
• You will seek medical attention if you experience any unusual side effects
• The treatment is solely for your own use
• You will read the patient information leaflet supplied with your medication

What is the name of your GP surgery and do you consent to us contacting them about your treatment?

Do you consent to us accessing your GP records? This is advised so we can clinically assess suitability.