referral of asthmatic patients

Management: Situations indicating referral of patients with asthma. 1) uncertainty about the diagnosis 2) instability or partial response to treatment 3) frequent use of inhaled beta-adrenergic agonists or adjustments in therapeutic regimens 4) requirement of multiple medications & frequent need for systemic glucocorticoids 5) concern regarding adverse effects of therapy 6) identification of allergens or other environmental triggers 7) consideration of allergen immunotherapy 8) need for intensive education for the patients &/or primary care-giver 9) family dynamics that interfere with patient care 10) chronic cough refractory to the usual therapy 11) coexisting illnesses that complicate management 12) recurrent absences form school or work 13) continuing nocturnal episodes 14) inability to participate in normal daily activities & sports 15) excessive lability of pulmonary function 16) preventative measures required for high-risk patients 17) sudden severe attacks, frequent hospitalizations & emergency room visits 18) loss of consciousness or seizures

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998