When Is It Time to Refer a Patient with Asthma or COPD to a Specialist?

Chronic lower respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), remain serious health concerns in the United States. These conditions are often presented to primary care physicians before reaching a specialist.

Meredith McCormack, MD, MHS, associate professor of medicine in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University, talked about managing asthma and COPD in the primary care setting and when it’s time to refer a patient to a specialist.

“One of the things that we talk to primary care doctors about is just actually the job of making the diagnosis,” McCormack explained at the American College of Physicians Internal Medicine Meeting (ACP 2017) in San Diego, California. “That involves taking into account a patient’s presenting complaints and respiratory symptoms, and then confirming the diagnosis with diagnostic testing.”

Both asthma and COPD are primarily treated with inhalers, however, the first-line medication tends to differ. While primary care physicians can treat the conditions, there are times when patients should be referred to pulmonologists.

“When patients have been on a medication and potentially the medication’s been titrated so additional medications have been added, and they’re either having frequent exacerbations, and that could be COPD exacerbations or asthma exacerbations,” McCormack continued, “or they’re still having uncontrolled symptoms, so they’re complaining of symptoms that don’t seem to be responding to medications, those are times.”

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