ASTHMA-GUIDELINES FOR REFERRAL TO A SPECIALIST

• Adults requiring step 4 care; consider referral if requiring step 3 care
• Kids requiring step 3 or 4 care (or <3yo and requiring step 2 care); consider referral if requiring step 2 and > 3yo
• > 2 courses of systemic steroids in 1y
• Not meeting goals of tx after 3-6mos of tx, sometimes earlier
• History of life-threatening asthma exacerbation
• Atypical presentation or uncertain diagnosis
• Complicating conditions, e.g. sinusitis, nasal polyps, aspergillosis, severe rhinitis, vocal cord dysfunction, GERD, other COPD
• When additional diagnostic testing is needed (allergy skin testing, complete PFT's, provocative testing, etc.)
• Additional education/guidance is needed, e.g. with compliance problems, allergy avoidance, etc.

Sources include:

1. AMA Continuing Medical Education Program, "Managing Asthma Today (I): Integrating New Concepts" AMA, 1997
2. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program Expert Panel Report II. "Guideline for the Diagnosis and Management of Asthma." February, 1997 [The report of a multidisciplinary expert panel which reviewed published literature to formulate evidence-based recommendations].