Should I take my 4-year-old to a physician who specializes in asthma?
Of the nearly 7 million children with asthma in the United States, the majority are diagnosed and initially treated by their primary care physician. If your child’s asthma is mild in severity and well controlled, there may be no reason to see an asthma specialist, pulmonologist, or allergist.
The key phrase in the last sentence is well controlled. According to the guidelines established by the National Asthma Education and Prevention Program (NAEPP), asthma control has been achieved when your child has no coughing, no difficulty in breathing, no nighttime awakening because of cough or wheeze, no acute asthma episodes, no absences from school or activities, and the parent or caregiver has not missed time from work due to the child’s asthma.
Objectively, your child should have nor-mal or near-normal lung function. If these criteria are fulfilled, your child’s asthma is well controlled. You should arrange for your child to see an asthma specialist if your child’s asthma is active for most days, if there are frequent nighttime asthma symptoms that interfere with sleep and rest, if your child is absent from preschool because of asthma symptoms, or if your child requires hospital emergency room visits for asthma.
You should also consider seeking a consultation with an asthma expert if you (or your older child) believe that asthma symptoms are not controllable, or if you do not understand how to take care of those symptoms. You might seek consultation from either a pediatric pulmonologist or from a pediatric allergist. After your child has undergone the appropriate evaluation, you and the specialist can decide whether the child requires continuing ongoing care from an asthma specialist or if your pediatrician can resume caring for your child’s asthma.
The most recent 2007 update of the NAEPP’s Expert Panel Report addresses the question of when infants and children 5 years of age or younger should be referred to an asthma specialist and when children aged 5 to 11 should be referred.
You should bring your child to an asthma specialist if your child has experienced an asthma exacerbation requiring hospitalization (inpatient care) and/or if therapy with either omalizumab or immunotherapy (allergy shots) is being considered. Consultation with an asthma specialist is also recommended for all young children with moderate or severe persistent asthma. Similarly, referral to an asthma specialist should be considered for infants and very young children with mild persistent asthma.
Gemma’s comment: Yes! The focused attention of both physician and patient is all-important. During her early years, my daughter’s allergies and asthma symptoms were repeatedly overlooked by the busy pediatricians who saw her only for a few overbooked minutes in a crowded office full of crying babies and frazzled moms.