How to Choose an Asthma Specialist

Your primary care physician (PCP) or pediatrician may have been the one to diagnose your or your child's asthma, and there are some times when them managing care makes sense. However, seeking out an asthma specialist such as a pulmonologist, allergist, or respiratory therapist is often ideal for many reasons.

Above all, asthma specialists focus their practices on asthma and conditions like it and are more likely to be on top of that latest research in the field. It's simply impossible for a PCP, who deals with a variety of health issues on a daily basis, to know every nuance of and development in each and every area of medicine.

The best asthma specialist for you or your child depends largely on the type of asthma and how severe symptoms are.

When You Need an Asthma Specialist

Asthma is a complex condition that comes in numerous forms. A mild case with obvious triggers that responds well to medication may not warrant a visit with a specialist. However, it's rarely that simple—especially in the long term.

You should consider an asthma specialist for you or your child if you or they:

• Have a life-threatening asthma attack, intubation, or admission to a hospital or intensive care unit for asthma
• Have poorly controlled despite three to six months of consistent treatment
• Are interested in allergy shots to help control asthma triggered by allergens
• Have worsening asthma despite using oral steroids
• Have moderate persistent or more severe asthma
• Need asthma education

Your primary care physician may refer you or your child to an asthma specialist if you/your child:

• Need more diagnostic testing such as a challenge test, skin test, or lung function test
• Have asthma symptoms or responses to treatment that aren't typical
• May have cough-variant asthma, occupational asthma, nocturnal asthma, or exercise-induced asthma

Benefits of Seeing an Asthma Specialist

Asthma actually doesn't fall under just one area of medicine, so it's treated by several types of specialists, including:

• Pulmonologists (adult and pediatric)
• Allergist/Immunologists
• Respiratory therapists and pulmonary rehabilitation specialists

Among the key benefits of seeing an asthma specialist is that they are typically among the most up-to-date when it comes to:

• The latest asthma research
• Asthma medications and their use
• Standards and advances in asthma care

They also may be better able to educate you about your condition and teach you how to properly use your inhaler(s).

Pulmonologists

A pulmonologist is a doctor who specializes in preventing, diagnosing, and treating lung and respiratory illnesses in adults. These include asthma as well as a diverse range of other conditions including bronchitis, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and lung cancer.

A pediatric pulmonologist specializes in breathing problems in children including asthma, chronic cough, cystic fibrosis, and lung disease in premature babies. They'll typically treat someone until they turn 21.

Your primary care doctor may refer you to a pulmonologist if you or your child have asthma, but especially if it is severe. In the United States, the average wait time for the first appointment with a pulmonologist is about 25 days.

Pulmonologist Training

Pulmonology is a subspecialty of internal medicine. To become a pulmonologist, doctors complete a three-year program in internal medicine and then at least two years of additional pulmonary disease training.

Pediatric pulmonologists, after medical school, complete a three-year residency in general pediatrics, and then a three-year fellowship in pediatric pulmonology.

What They Can Do For You

Their extra education and experience in diagnosing and treating a narrow range of illness gives pulmonologists a broader understanding of not only asthma and your lungs, but the impact asthma and respiratory diseases have on the body (beyond the respiratory system). That means they can:

• Help you manage asthma alongside other health conditions
• Identify exacerbating factors such as sleep apnea or GERD

Pulmonologists have a greater understanding of asthma diagnostic tests and procedures and often have more ready access to diagnostic tools. This means they're better able to:

• Provide a more in-depth diagnosis of your asthma (e.g., is it nocturnal as well as exercise-induced)
• Confirm (or rule out) a difficult diagnosis
• Evaluate the success of your treatment regimen
• Track your progress

Pulmonologists are also familiar with the medications and procedures used for certain types of asthma.

When You May Not Need a Pulmonologist

If your asthma is primarily due to allergies, a pulmonologist may not be the best choice for you.

If you have mild-to-moderate asthma that's well-controlled with a simple regimen, you're unlikely to need a pulmonologist.

Allergist/Immunologist

If you have allergic asthma or occupational asthma, or your PCP suspects you do, you may be referred to an allergist/immunologist.

An allergist/immunologist is a doctor who manages allergies, asthma, and diseases of the immune system in both children and adults. Allergies includes not just seasonal allergies, but environmental, drug, and food allergies, as well as allergy-related skin conditions. Allergist/immunologists also are experts at treating severe allergic reactions.

The U.S. has a growing shortage of allergist/immunologists, and the wait time for initial appointments in some areas can be more than two months.

Allergist/Immunologist Training

All allergy/immunology doctors complete a three- to four-year residency program, usually in internal medicine or pediatrics. They then spend two years in allergy and immunology training.

What They Can Do For You

Allergies essentially stem from a complex mistake made by your immune system. When you have allergies, your body considers a harmless substance like pollen or a peanut as a threat.

Just as it would with a virus or bacteria, your immune system launches an attack on the allergen. That attack is what's responsible for symptoms of allergies and allergic asthma.

An allergist/immunologist understands the complicated processes in your body that lead to allergies and the asthma attacks they can cause. These professionals can:

• Identify whether your asthma is allergy-induced
• Identify what you're allergic to
• Treat both your allergies and your asthma
• Help you learn how to avoid allergens

Like pulmonologists, they're also experts when it comes to asthma medications, evaluating the effectiveness of your treatment(s), and tracking your progress.

When You May Not Need an Allergist/Immunologist

If you don't have allergic asthma or any allergy-related issues, you're unlikely to benefit from seeing an allergist/immunologist.

If you have allergic asthma that's mild and well-controlled with a simple regimen, you're also unlikely to need an allergist/immunologist.

Respiratory Therapist/Pulmonary Rehab Specialist

Respiratory therapists are not doctors, but healthcare providers who have special training in the lungs and respiratory system and primarily treat asthma through lung exercises. Most of them work in hospitals.

A respiratory therapist, physical therapist, registered nurse, or exercise physiologist can get further training to become a pulmonary rehabilitation (PR) specialist.

Your doctor may refer you to this type of therapist after a severe asthma attack.

Respiratory Therapist/Pulmonary Rehab Specialist Training

Respiratory therapists must:

• Get either an associates degree or bachelor's degree in respiratory therapy or pulmonary science
• Pass a certification exam from the National Board for Respiratory Care
• Earn a state license, which requires on-going education to maintain

To become a PR specialist, they can take a short course to earn a specialized certificate or receive on-the-job training at a facility with a program certified by the American Association of Cardiovascular and Pulmonary Rehabilitation.

What They Can Do For You

If you need better asthma control, frequently find yourself short of breath, or want to be able to exercise more, you may benefit from seeing a respiratory therapist, especially one who specializes in pulmonary rehabilitation.

Respiratory therapists' and pulmonary rehabilitation specialists' care isn't intended to replace that of your physicians, but it can be a very helpful addition to it.

A respiratory therapist can:

• Assess your asthma and lung function
• Treat an acute asthma attack
• Teach you breathing exercises that help restore the normal function of your lungs
• Teach you to properly use an inhaler
• Work with doctors to determine treatments

PR specialists:

• Provide significant education on how to live with asthma
• Help you understand your treatment regimen
• Identify any risk factors that may exacerbate your condition
• Suggest beneficial nutritional changes and other lifestyle modifications
• Design and monitor an exercise regimen for you (beyond just lung exercises)

Research published in 2020 suggests that pulmonary rehabilitation is beneficial for people with any stage of asthma, noting that it:

• Improves exercise capacity
• Leads to better asthma control
• Improves quality of life
• Reduces wheezing and bronchial inflammation
• Improves anxiety and depression

When You May Not Need a Respiratory Therapist/PR Specialist

Respiratory therapists and PR specialists can't prescribe you asthma medications, so they're not a replacement for any of your doctors. However, if your PCP is currently overseeing your asthma treatment, one of these therapists may be able to provide valuable insight and information.

If you're physically fit, don't have severe asthma attacks, and are managing your condition well (under the care of a physician), you probably don't need these specialists.

Your Primary Care Provider

Your primary care doctor or provider is the leader of your personal healthcare team. PCPs who treat asthma frequently include:

• Pediatricians
• Internists
• Combined internal medicine and pediatrics doctors (a.k.a. med-peds)
• Family practitioners

Pediatric or family medicine nurse practitioners are also generally considered under the primary care umbrella.

For the many reasons listed above, a specialist is often the best provider to manage your asthma. However, there are some pros of seeing a PCP that are of a more practical nature and worth noting:

• Familiarity: Since you see your PCP for general health as well as acute illnesses and injuries, you've probably gotten to know each other fairly well. They may be able to spot lifestyle risk factors or changes in your health that may affect your asthma.
• Convenience: Your PCP can track your asthma progress when they see you for other problems or check-ups, which is probably more frequently than you see a specialist.
• Affordability: PCPs are almost always less expensive than specialists.
• Accessibility: In some areas, it may be far easier to get to a primary care doctor than an asthma specialist. It also may take less time to get an appointment.

If your asthma is uncomplicated, mild, and well-managed, seeing your PCP for care may be fine. If, however, your PCP thinks you should see a specialist, it's probably because they believe you need to see someone with more in-depth knowledge and experience in treating your condition. In that case, if it is possible (even if less convenient), taking that next step is best.

Why Haven't I Been Referred?

If you meet the criteria for a referral to a specialist yet your PCP hasn't referred you, it could be due to many reasons.

• Your PCP doesn't think they need help managing your/your child's asthma. Sometimes doctors don't know when to ask for help and may need a nudge from you. If you want a referral to an asthma specialist, ask for it.
• Your doctor may not know the latest guidelines for referral to an asthma specialist. Your PCP treats many diseases and needs to know many different guidelines, so it can be hard to keep up. You may want to go over guidelines with your doctor and ask if they think a referral is appropriate.
• The healthcare system may be getting in the way. Your area may not have the appropriate asthma specialists available, or you or your doctor may be trying to keep your healthcare costs low.

Finding a Specialist

There are many resources for researching asthma specialists in your area.

First, if you have insurance, check with your carrier to see who is in-network. Then, you can get recommendations from:

• Your PCP or your child's pediatrician
• Online reviews and directories, such as the one maintained by the American College of Allergy, Asthma and Immunology
• Friends, family, and co-workers

Remember, though, that identifying an asthma specialist in your area may not necessarily mean you can see them right away (or, in some cases, at all).

Factors that can delay or prevent you from seeing an asthma specialist include:

• They don't always accept new patients
• Long wait times
• They may not all be covered by your insurance
• Time to seek and secure necessary referrals

If possible, it's best to gather several names during your search.

Your First Appointment

When you go to your first appointment, be sure to bring any relevant medical records, including test results and medication lists (if applicable).

Have a conversation with the doctor to see if your goals and personalities appear compatible. Try your best to verify that the doctor has your best interests at heart, that the two of you seem able to get along as a doctor and patient, and that you are comfortable with the doctor’s level of expertise as well as their approach toward treating your asthma.

Ultimately, if you don’t think it will work out, don’t feel afraid to tell them. You have no obligation to stick with a doctor simply because you made one appointment with them (or have had several, for that matter).

A Word From Verywell

No matter what specialist you decide on, be sure to keep your PCP informed about who you're seeing and what treatments you're using. The PCP doesn't just hand you off—their job is to function as the quarterback of your healthcare team, and they can perform that job better if they know what all of the other players are doing.