A person should contact a pulmonologist, allergy specialist or immunologist if any of the following problems are present:

• Specialist must be consulted if the asthma symptoms are not controlled even after 3- 6 months of therapy; i.e.   more than one rescue inhaler use per month, oral steroids used more than 2 times per year, step 4 therapy required ( step 2 or higher if patient aged less than 3 years)

• For immunotherapy.

• Refractory cough.

• Abnormal chest radiograph finding.

• Life –threatening asthma exacerbations.

• Intensive Asthma patient education.

• Poor quality of life.

• Persistent chest pain or atypical features.

• Persistent shortness of breath.

• Persistent or fixed wheezing.

• Spirometry or PEFs don't fit the clinical picture.

• Suspected occupational asthma.

• Stridor.

• Weight loss.

If significant social, psychological, or family problem is present additional referral to the psychologist or family counselor may be needed.

Last edited 12-6-2010