General Guidelines for Referral to an Asthma Specialist

An asthma specialist is usually a fellowship-trained allergist or pulmonologist or, sometimes, a doctor with skill in asthma management gained through extra training and experience. If you are a person or caregiver of a person with asthma, talk to your doctor first if you think you need to see a specialist. Referral to a specialist in asthma care is recommended by the NHLBI guidelines if:

  • Patient has had a life-threatening asthma exacerbation.
  • Patient is not meeting the goals of asthma therapy after 3–6 months of treatment. An earlier referral or consultation is appropriate if the physician concludes that the patient is unresponsive to therapy.
  • Signs and symptoms are atypical, or there are problems in differential diagnosis.
  • Other conditions complicate asthma or its diagnosis (e.g., sinusitis, nasal polyps, aspergillosis, severe rhinitis, VCD, GERD, COPD).
  • Additional diagnostic testing is indicated (e.g., allergy skin testing, rhinoscopy, complete pulmonary function studies, provocative challenge, bronchoscopy).
  • Patient requires additional education and guidance on complications of therapy, problems with adherence, or allergen avoidance.
  • Patient is being considered for immunotherapy.
  • Patient requires step 4 care or higher (step 3 for children 0–4 years of age). Consider referral if patient requires step 3 care (step 2 for children 0–4 years of age).
  • Patient has required more than two bursts of oral corticosteroids in 1 year or has an exacerbation requiring hospitalization.
  • Patient requires confirmation of a history that suggests that an occupational or environmental inhalant or ingested substance is provoking or contributing to asthma.
  • Depending on the complexities of diagnosis, treatment, or the intervention required in the work environment, it may be appropriate in some cases for the specialist to manage the patient over a period of time or to co-manage with the PCP.
  • In addition, patients who have significant psychiatric, psychosocial, or family problems that interfere with their asthma therapy may need referral to an appropriate mental health professional for counseling or treatment. These problems have been shown to interfere with a patient’s ability to adhere to treatment.