Task%based%learning%(TBL)%Guide%

TBL%Topic:%Bronchial%asthma%in%primary%care%clinic%

Semester:%6%

Facilitator:%A/P%Dr.%Verna%Lee%Kar%Mun%

TBL%Objectives:%

At#the#completion#of#the#one.hour#TBL,#semester#6#medical#students#should#be#able#to:#

1.! Make#an#accurate#diagnosis#of#bronchial#asthma#in#children#and#adults#
2.! Differentiate#mild,#moderate,#severe#&#life#threatening#acute#exacerbation#of#bronchial#asthma#
3.! Assess#the#control#of#asthma#in#patients#follow.up#in#primary#care#
4.! Assess#patient#compliance#to#allergen#avoidance,#follow#up#&#medications#
5.! Assess#patients’#fear#and#concern#of#the#illness#and#medications#prescribed#
6.! Demonstrate#&#educate#patients#on#the#correct#technique#of#using#the#peak#expiratory#flow#
meter#and#metered.dose#inhaler#
7.! Describe#the#use#of#asthma#diary#and#peak#flow#chart#in#patients’#follow.up#
8.! Differentiate#chronic#obstructive#airway#disease#and#asthma#

TBL%Activity:%

1.! Students#are#divided#into#2#groups#
2.! Each#group#is#to#discuss#ONE#case#scenario#below#(1#&#2).##
3.! ALL#students#have#to#prepare#scenario#3#for#discussion#in#the#class.##
4.! Each#group#is#to#prepare#a#PowerPoint#presentation#for#maximum#10.minutes#(10#slides),#
followed#by#a#role.play#for#10.minutes,#and#discussion/feedback#by#other#students#for#
maximum#10.minutes.#

Case%Scenarios%&%Issues%for%group%discussion:%

1.! A#5.year.old#boy#is#brought#to#the#clinic#by#the#grandmother#for#recurrent#night#cough#for#2#
months.#He#is#otherwise#healthy.#He#is#the#only#child.#Clinically,#he#is#comfortable,#afebrile#
and#active.#Weight#and#height#is#at#the#50th#centile#on#the#growth#chart#for#boys.#There#is#no#
cervical#lymphadenopathy,#and#chest#examinations#are#normal.##
%
1.1!What%further%relevant%history%would%you%ask%the%grandmother?%
1.2!What%further%relevant%physical%assessment%would%you%perform%in%this%boy?%
1.3!Would%you%order%or%do%any%tests%in%the%clinic?%
1.4!Explain%the%diagnosis%of%asthma%to%the%grandmother%(Role%play)%
1.5!Explain%how%to%use%a%salbutamol%metered%dose%inhaler%(Role%play)%
%
%
%
%
 2.! An#18.year.old#college#student#presents#to#the#health#clinic#with#one.day#history#of#difficulty#
in#breathing#and#wheezing#following#cough,#sore#throat#and#fever#for#a#week.#She#has#
childhood#asthma.##
#
2.1!What%further%relevant%physical%assessment%would%you%perform%immediately?%
2.2!What%physical%examination%findings%would%alert%you%that%she%need%to%be%referred%to%
the%emergency%department%urgently?%
2.3!What%relevant%history%you%would%ask%to%assess%the%control%of%her%asthma?%
2.4!Explain%to%patient%how%to%use%an%asthma%diary%&%peak%flow%meter/chart%at%home%(Role%
play)%%
%

3.! A#52.year.old#Indian#man,#a#night.shift#security#guard#in#a#government#school,#presents#to#
the#clinic#with#cough,#runny#nose#&#sore#throat#for#2#days.#He#smokes#20.25#cigarettes#daily#
for#the#past#30#years.#On#further#questioning,#he#has#been#having#common#cold#symptoms#
almost#once#every#4.6#weeks#needing#cough#suppressant,#antihistamine#and#paracetamol#for#
the#past#6#months#(documented#in#the#medical#records#of#the#clinic).#He#has#no#chronic#
cough#and#sleep#very#well#after#his#night#shift#work.#He#has#strong#family#history#of#atopy.#
#
Clinically,#he#is#comfortable,#afebrile,#blood#pressure#130/80#mmHg,#pulse#rate#80/min.#
There#is#no#clubbing,#and#he#is#not#in#respiratory#distress.#Chest#examination#show#expiratory#
rhonchi#with#prolonged#expiratory#phase,#no#crepitations.#
#
3.1!What%are%the%diagnosis%and%differential%diagnosis?%Why?%
3.2!How%do%you%confirm%the%diagnosis?%

PostZTBL%activity:%

Students#are#encouraged#to#utilise#the#learning#experience#in#the#classroom#to#consolidate#their#
knowledge#in#managing#patients#with#bronchial#asthma#with#regards#to#the#common#primary#care#
issues#below:#

1.! Diagnosis#
2.! Recognize#severity#of#exacerbation#&#emergency#referral#to#hospital#
3.! Giving#appropriate#patient.centred#non.pharmacological#advice#
4.! Rescue#&#Preventive#care#

References:%

1.! Global#Initiative#for#Asthma:#http://www.ginasthma.org/documents/1#
2.! British#Thoracic#Society#–#BTS/SIGN#Asthma#Guideline:#https://www.brit.
thoracic.org.uk/guidelines.and.quality.standards/asthma.guideline/#
#