| When a child <1 year old has recurrent episodes of wheezing, at which time congenital causes of wheezing, rather than asthma, are more common. |
| When diagnosis is in doubt, especially in the early wheezer. |
| If asthma is difficult to control, consider other diagnoses or referral. |
| When a child with suspected asthma does not respond to inhaled corticosteroids after 8 weeks of good adherence. |
| Refer children ≥5 years old with persistent type asthma for diagnostic spirometry at a local facility if this is not reliably available in the practice. Spirometry for younger children (>3 years old) can be modified and often is useful in aiding diagnosis. |
| Refer to a allergy specialist for skin testing if a specific allergen is not obvious from the history and clinical allergy assessment. |
| Refer to an asthma educator for assistance in control assessment (as well as instruction in action plans and inhaler technique). |