Table 21.

Indications for referral to a specialist

Children requiring step 3 care of higher (step 2 for children under 4 years of age)

Children on or those who may be candidates for immunotherapy

Uncontrolled patients not meeting goals of therapy within 3 months of after initiation of treatment

Children who have had a life-threatening asthma exacerbation

Children in whom symptoms are atypical or if the diagnosis has not been established

Children with comorbid or complicating factors, including chronic sinusitis, nasal polyps, gastroesophageal reflux, allergic rhinitis, allergic bronchopulmonary aspergillosis, etc.

Children in whom additional diagnostic testing is needed, such as allergy testing, pulmonary function tests, rhinolaryngoscopy, provocation challenge, or bronchoscopy

Children who require systemic corticosteroids on a chronic basis or who have more than two steroid bursts in 1 year

Children who have been hospitalized for asthma

Children with exercise-induced asthma or other special circumstances

Children and/or parents who require or desire counseling on issues related to compliance, environmental evaluation and control, medication usage, device usage, peak flow meter usage, or any other additional asthma education

Children who may have an unusual exposure which may be provoking or contributing to asthma