Take a deep breath

Jane, a 46-year-old executive, presents with poorly controlled asthma. Jane has never smoked and does not recall any occupational exposure to allergens.

She lives with her husband and two young daughters. They have lived in the same house for about 11 years  and have no pets.

About 10 years ago, Jane started to experience seasonal symptoms of cough and chest tightness associated with sneezing and rhinorrhoea. Inhaled corticosteroid preventer therapy gives suboptimal symptom relief.

Each year, Jane experiences several significant exacerbations requiring oral prednisolone, especially during winter. Symptom control is better when Jane is on holiday.

On specialist review, Jane complained of cough and wheeze waking her from sleep about three nights per week.

This was partially relieved with Ventolin. Her asthma medication was recently increased to Seretide 250/25µg by metered-dose inhaler,