As well as general questions about asthma symptoms, consider the following:

1 Atopy is strongly linked with asthma

• Over 90% of children and 80% of adults with asthma are atopic.^{31, 32}
• The presence of eczema is a marker of more severe and/or persistent asthma.^33,34
• Children still wheezing at 6 years are more likely to have a maternal history of asthma and elevated serum IgE levels.¹²
• Sensitisation to house dust mite and the mould, Alternaria is associated with a high incidence of asthma.^{35,36 [LE I]}

2 Rhinitis

Rhinitis of any cause is a risk factor for asthma (including allergic rhinitis).^37,38

3 Are allergens triggering asthma symptoms?

Timing of symptoms

• Perennial (persistent) or seasonal (intermittent) symptoms.
• Time of day, for example, allergy symptoms provoked by house dust mite are often worse at night and first thing in the morning.
• Time of week, for example, if at weekends consider some activity such as horse-riding, or environment such as old dusty weekenders.

Occupation

• Is there a slow improvement away from the workplace?
• What potential allergen exposures are occurring at work?

Geographic associations of symptoms

• Such as work, home or holidays.

Environmental descriptors

• Conditions at home, such as house age, construction, ventilation, dampness, floor coverings, room clutter, bedding.
• Soft toys in the bedroom.
• Pets in the home.
• Smoking history of family members.

When should referral to an allergy specialist be considered?

• When there is evidence of continuing poor asthma control despite regular use of preventer medication or if there is regular use of bronchodilators.
• When there are other allergic diseases.
• When foods or food allergy are suspected as asthma triggers.
• In cases of occupational allergy.
• If immunotherapy is contemplated.
• When patients express an interest in exploring allergy issues.
• For further education regarding allergy issues of patient or family.