A 17‑year‑old student, Maya, arrives at her GP practice late on a Thursday afternoon, looking more anxious than unwell at first glance. She apologises for being out of breath, explaining that the walk from the bus stop “felt like running uphill.” Over the past three days she has developed a tightening in her chest and a dry, irritating cough that keeps her awake at night. She insists she hasn’t been ill, hasn’t had a fever, and hasn’t produced any sputum. What worries her most is that she can no longer keep up with netball training, something she normally loves.

As she talks, she shifts forward in the chair, pausing between sentences to catch her breath. Her respiratory rate is slightly raised, and her oxygen saturation sits just below normal. When you listen to her chest, the wheeze is unmistakable – broad, musical, and present throughout expiration. Her peak flow is significantly reduced compared with what would be expected for her age and height.

When you ask about any past breathing problems, she hesitates before mentioning that she had asthma as a child. She hasn’t used an inhaler for years and assumed she had “grown out of it.” The turning point in the consultation comes when she quietly adds that she has been vaping daily for the past six months. She describes it as something she does “mostly with friends,” and she had always believed it was harmless—certainly safer than smoking. She noticed her chest tightening after long vaping sessions but dismissed it as coincidence.

As the conversation unfolds, it becomes clear that her symptoms are unlikely to be a simple viral cough. The pattern of wheeze, the reduced peak flow, and the recent irritant exposure all point towards a flare of airway hyper‑responsiveness. She looks startled when you explain that even if asthma symptoms fade during adolescence, the underlying sensitivity of the airways often remains. Vaping, with its heated aerosols and chemical flavourings, can be enough to provoke inflammation in someone with a history like hers.

Maya’s expression shifts from worry to something closer to guilt. She asks whether she has caused permanent damage, whether she will still be able to play sport, and whether this means she has “messed up” her lungs for good. The consultation becomes as much about reassurance and education as it is about immediate treatment. You explore her assumptions about vaping, her reasons for starting, and the social pressures that made it feel normal. She listens carefully, relieved that the focus is on understanding rather than judgement.

By the end of the appointment, she is breathing more easily after bronchodilator treatment, but she is also processing a new understanding of her own health. She leaves with a plan for follow‑up, a renewed sense of agency, and a lingering uncertainty about how to talk to her friends about stepping back from vaping.

Before she goes, you ask her to reflect on one question – one that will shape how she approaches her health from here: