Indications for referring a patient with asthma to a specialist:
(1) severe, persistent asthma at any age
(2) one or more life-threatening asthma exacerbations
(3) child <= 4 years of age with moderate, persistent asthma
(4) difficulty in making the diagnosis of asthma (atypical signs or symptoms, concurrent conditions, etc)
(5) need to identify allergens or other triggers causing exacerbations
(6) need to perform specialized diagnostic testing such as a pulmonary function challenge tests or bronchoscopy
(7) need for specialized counseling and education
Therapeutic concerns:
(1) poor asthma control with conventional therapy or failure to meet treatment goals after several weeks of appropriate therapy
(2) significant adverse effects during conventional therapy
(3) administration of immunotherapy
(4) requiring high doses of corticosteroids (continuous oral, high-dose inhaled, 3 or more courses of oral steroids within the past year)
(5) comorbid conditions that make management difficult
In addition, the patient and family may benefit from referral to other specialists (to a psychiatrist, family counselor, dietician, etc).
