Interdisciplinary Resources - Can a Specialist Help?

Referral Guidelines:

You may want to see a doctor specializing in treating asthma (a pulmonologist or an allergist/immunologist) if your child’s diagnosis is uncertain, the side effects of the medications are unbearable, or the asthma is difficult to control with frequent exacerbations (asthma attacks) (UpToDate, 2014). 

A pulmonologist is a doctor who specializes in the diagnosis and treatment of pulmonary (lung) conditions.  Pulmonologists are helpful when a pulmonary (lung) disease other than asthma is suspected or when additional pulmonary testing (tests evaluating the how well the lungs function) or bronchoscopy (a procedure that allows the doctor to look inside the lower respiratory tract) are needed (UpToDate, 2014).  

http://www.return2health.net/articles/healthy-lungs/

An allergist (or immunologist) is a doctor who specializes in the diagnosis and treatment of allergies, asthma, and immune deficiency disorders.  Seeing an allergists/immunologist is helpful when allergic triggers need evaluation or allergy symptoms are uncontrollable.  Allergists are familiar with the many types of indoor and outdoor allergens that may impact asthma and breathing, have received special training in how to identify these environmental triggers, and can provide advice on how to avoid them (UpToDate, 2014; AAAAI, 2014).  

Learn about common asthma triggers here – http://www.epa.gov/asthma/triggers.html.

Patients with allergic asthma (asthma triggered by allergens) who see an allergist/immunologist have been shown to experience improved outcomes (AAAAI, 2014).  While not every child with asthma needs to see a specialist, for many, asthma care in children provided by a specialist as the usual source of care has been shown to improve both the degree of care received and be more consistent with national guidelines (Lieberman, 2012).  Patients with asthma who see allergists (as opposed to primary care providers) report experiencing wide-ranging outcome improvement, including:

•  Higher quality of life
• Fewer problems controlling asthma
• Less severe symptoms 
• Higher patient satisfaction
• Better understanding of how to management their asthma
•  Fewer asthma-related hospitalizations
• Fewer asthma-related unscheduled doctor visits
• Less frequent use of rescue medication and increased use of inhaled steroids

(Lieberman, 2012)

The American Academy of Allergy, Asthma, and Immunology has developed referral guidelines to help determine when referral to an allergist is necessary.  You can ask your health care provider if your child might benefit from a referral (AAAAI, 2014). Those who might benefit from a referral to an allergist/immunologist include:

• Children with asthma that is not well controlled 
• Children with asthma that is classified as moderate or severe persistent asthma
• Children who frequently use rescuer/reliever medications
• Children who require emergency room care for asthma attacks
•  Children with a possible connection between their asthma and an unavoidable airborne allergens who also have a poor response to their medications, desire to avoid long-term medication, or have other allergy symptoms (like a frequent runny nose and itchy eyes)
• Children and families requiring education about possible environmental triggers
• Any child with potentially fatal asthma, including those with a previous life threatening episode or intubation (intubation = tube inserted to help with breathing). 

(AAAAI, 2014)

Patients may also benefit from joining a local Educational Support Group (ESG).  The Asthma and Allergy Foundation of America (AAFA) has support groups in many states.  These groups provide  emotional support while offering helpful information about asthma and allergies.  Search for a group in your state here: 
HTTP://WWW.AAFA.ORG/ESG_SEARCH.CFM. You can also start your own AAFA Educational Support Group by calling AAFA at 800-7-ASTHMA.