Should You See an Asthma Specialist or Your Primary Care Doctor?

Do you need to see an asthma specialist? While asthma is a common disease and commonly treated by a variety of asthma doctors, there are a number of reasons to consider seeing an asthma specialist.

Specialists, as the name implies, focus on a narrow range of medical conditions. There are 2 types of physicians that are considered an asthma specialist:

• Allergist/ Immunologist
• Pulmonologist

Your primary care doctor is the general or leader of your personal healthcare team. In general, most primary care doctors are qualified by experience and training in the treatment of asthma. The article later goes into why you want or need to see an asthma specialist. Primary care doctors treating asthma include:

• Pediatrician
• Internist
• Med Peds
• Family Medicine

Advanced practice nurses also can provide asthma care when they are being supervised by a physician.

You or your child should consider seeing an asthma specialist:

• Following a life-threatening asthma attack, intubation, or admission to an intensive care unit for asthma.
• Following an asthma attack requiring hospitalization.
• For poorly controlled asthma despite following your doctor's instructions and taking medications appropriately after 3 to 6 months of treatment.
• If you want an evaluation for allergy shots to help control asthma triggers.
• If you use oral steroids to treat worsening asthma symptoms
• If your current asthma severity is moderate persistent or worse.
• If you or your child need additional asthma education.

If your asthma remains poorly controlled, an asthma specialist may consider other diagnoses that could be contributing to your worsening asthma such as:

• GERD
• Sinusitis
• Allergic Rhinitis
• COPD
• Obesity
• Obstructive Sleep Apnea

Your primary care physician might also consider referring you to an asthma specialist if:

• You need another diagnostic testing such as challenge testing, skin testing, or lung function testing.
• Your asthma symptoms or response to treatment are not typical.

Your primary care physician suspects any of the following conditions:

• Cough Variant Asthma
• Occupational Asthma
• Nocturnal Asthma
• Exercise Induced Asthma

While you might be surprised, many patients have not seen an asthma specialist despite meeting one or more of the previously mentioned reasons to see an asthma specialist. Why would there be so many missed opportunities for referral to an asthma specialist? Consider these reasons:

• Your doctor does not yet think he or she needs help managing your or your child's asthma. Sometimes doctors don't know when to ask for help and may need a nudge from you. If you want you or your child to see an asthma specialist, you should not have any reservations about asking for a referral.
• Your doctor may not be up to date with the latest guidelines for referral to an asthma specialist. Your primary care physician is responsible for many different guidelines for many different diseases, so it can be hard to keep up. You may proactively share the guideline with your doctor and ask if they think a referral is appropriate.
• The health care system may be getting in the way. Sometimes there may be a number of hurdles to getting a referral. Additionally, there may not be an asthma specialist near you or you or your doctor may be trying to decrease your healthcare costs.

You will probably get different answers depending on who you ask. Importantly, it is difficult to answer this question definitively because no randomized controlled trials, the gold standard for research, have been performed. While few differences have been seen between allergists and pulmonologists, these sub specialists did better than primary care doctors in a number of areas. However, this type of research has a number of potential biases that make it difficult to make a clear, definitive statement about this. If you meet one of the criteria previously mentioned, your asthma very well may improve by seeing an asthma specialist.