The First Visit Outline

Why do patients get referred to The Childrens Asthma Clinic?

-         Most patients come with problems regarding cough, asthma, or allergies.

The 1st visit lasts approximately 30 minutes. The visit assess the patient's history, physical examination, pulmonary function and sometimes skin testing, for the diagnosis and management of the problem.

There is a questionnaire to fill out. The questionnaire asks the patient's past history, risk factors for various diseases, medications, previous investigations, and about the patient's environment. The form is updated each visit. If you have tests that you want reviewed then you should ensure that the referring physician has sent them, or that you bring them with you.

The patient then has their height, weight, blood pressure, heart rate, respiratory rate and sometimes temperature taken.

For those old enough to understand instruction, we do pulmonary function testing. Usually this is a 6-year old child. We do start training the younger children at age 4. It takes about 3-visits and they can do the test well.

Pulmonary function testing adds an objective measurement to the visits assessment. There are 2-types. Office spirometry, which measures airway caliber (bigger numbers mean bigger holes and less asthma). The second test, end expiratory nitric oxide (eNO), measures airway inflammation. For both of these tests the patient is required to take a deep breathe, place a cardboard tube in their mouth and blow out. The test is repeated until  judged to be reliable. The patient is then given 2-puffs of salbutamol and the spirometry test repeated in 15 minutes. This is to see if there is any bronchoconstriction or airway tightness.

You should be aware that the eNO is not covered by the Ministry of Health at this time. Currently there is no charge for those that wish to do the test (please see the eNO section).

If skin testing is necessary then it is done at this time. We do allergen testing by the prick method. This requires placing a small drop of liquid test material on the forearm and 'pricking it'. There is no blood and we do not use the word 'needle'. The test is likely very different than what the parent might remember as a child. The biggest problem is the fear that the children sometimes have.

The patient and parents then are interviewed by the doctor. Please note that the child is asked the questions, and not the parent. We find this important for the child's comfort level in the office, and their long term understanding of their disease. The parent will be asked similar questions.

We then answer your question, or if we cannot, then arrange a plan of investigation. In most cases no further tests are necessary. If treatment was required, then we follow-up to make sure the treatment was effective. If not effective, then we determine the 'why' (please see 'Treatment Failures' in the Educational Section).

In most cases, when the diagnosis is asthma then good control can be achieved. When the patient/parent is comfortable with the management, they and their family physician can decide on further follow-up. Some chose to continue follow-up in the office indefinitely. We do think that regular follow-up is necessary.

Notes

1. If you are on Advair or Symbicort, then we ask you not to use the puffer on the day of the visit. This is because these medications have a 12-hour bronchodilator in them and they make the office spirometry a bit more difficult to interpret.
2. If you are having skin testing (allergy testing) then you cannot have taken an antihistamine as follows:
   1. short acting antihistamines such as Benedryl or chloramphenamine within 72-hours of the test
   2. Long acting antihistamines such as Claritin, Reactine, Allergra, or Aerius (or their generic versions) within 1-week of the test.

For some children, stopping the antihistamine is difficult. In that case we will arrange for the allergy testing to be done by blood work.