Expert: Marc Rubin, RPh Asthma Educator - 7/14/2010

Question
Hi, I'm back again! Can you tell me the difference between an allergist and pulminist's treatment of a child with asthma? Currently my 7 year is treated by a pulminist.

Answer
Hi Bonnie, welcome back!

An allergist is a specialist dealing with issues of the immune system. Frequently titled Allergist/immunologist, their training targets how the body responds to external factors such as pollens, molds, bacteria. Your immune system is your body armor, with the skin being its' first line of defense. When the "defense" system has problems, such as being over-reactive,as in the case of asthma, they look to find the best approach to address the issue, and to help the patient achieve a "near-normal" life. By near-normal, I means that the patient needs to recognize and avoid triggers, plus, if needed, take appropriate medications at the appropriate times to prevent or diminish the reaction to the triggers. In addition to issues of allergies, also addressed are "broken" immune systems, where, for example, the body does not produce all the "weapons" to fight off infections. The assessment and proper treatment is essential for the patient to survive.

A pulmonologist, although also trained in treating asthma, have a wider scope of practice. From lung cancer to cystic fibrosis, chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and a myriad of other lung disorders. Many of these specialists only work in intensive care units alongside cardiologists. So while asthma is a part of their practice, more severe disorders get the greatest amount of their attention. There are pediatric pulmonologists that have a far greater focus on asthma due to the fact that in children, asthma is most often due to allergies and the affect on the immune system, whereas in adult onset asthma, workplace chemicals and other environmental factors trigger the lung inflammation, not allergens.

For children, I generally guide the family to allergists. But depending upon where they live, I also know and recommend some outstanding pediatric pulmonologists.

One thing that is important that I make clear here. A number of lung disorders have symptoms like asthma, and it is critical that the correct diagnosis is made. Allergists who are unable to get an asthmatic patient under control will refer the patient to a pulmonologist for a deeper reassessment.

The best quality health care is provided when improving the quality of life is the focal point of practice, and the best practitioners will seek out second opinions to protect the patient.

I hope this helps clarify the issue for you.

Sincerely,

Marc