He has had 4 previous episodes. The first attack occurred at 6 months and was called bronchiolitis. He required admission to hospital for 3 days. His attacks are usually precipitated by an URTI and don't respond consistently to beta agonists. In between attacks he is well and gaining weight. There is no history of diarrhoea or recurrent infections elsewhere. He is developing normally. He has missed several immunisations.

Both parents work and he is cared for by his grandmother and when she is unwell, by his auntie ( his mother's sister). He sees 2 GPs depending on who is caring for him during the day. He has also been seen on several occasions at A and E service.

Signs of respiratory distress, evidence of clubbing or chest deformity which would suggest chronic active disease. He has mild respiratory distress. His height and weight are on the 50^th percentile.