Table 4. Situations in Which Specialist Referral Should be Considered When Asthma Diagnosis is Inconclusive
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).