The first thing you will do is make an appointment with one of our clinic coordinators. The coordinator will let you know about any referrals or paperwork that you should bring with you to your child's appointment. Clinic coordinators can provide you with lots of information, such as directions to our office and parking information.

Our coordinator will also mail you a form to fill out about your child's medical history. It will help us if you fill out the form before your child's appointment and answer all the questions as completely as possible. If your child is already on medicine and has a spacer, please bring everything with you to the appointment, along with any recent chest X-rays.

Your child's first appointment

Your appointment begins at Registration. Once you have registered, you will meet the nurse who will measure your child's height and weight, check her heart and breathing rate, and measure her oxygen saturation level with a finger probe. Next, you will be escorted to the Pulmonary Function Lab for the spirometry breathing test (if your child is age 6 or older) or to an exam room.

In the Pulmonary Function Lab you will meet one of the respiratory therapists who will explain the spirometry procedure to you and your child. Spirometry takes about 15 minutes and involves your child putting his or her mouth on a tube, wearing nose clips, taking a big breath in and then blowing out as hard and fast as possible for at least six seconds. The mouthpiece is connected to a computer that prints out a report, which we will discuss with you.

Next you will go into an exam room. An attending physician (pediatric pulmonologist), fellow or nurse practitioner will come in to meet you and your child, review the history form you filled out, ask more questions about your child and do a physical exam. After reviewing all the information, your child's Asthma Program team will determine if your child has asthma or not. If your child has asthma, we then determine how severe it is and make treatment recommendations.

Asthma education

During your visit, we will educate you and your child about:

• What asthma is and what it isn't (there are many myths and misunderstandings about asthma)
• The risks and benefits of each medication
• What you can expect from the medications
• How to correctly administer each medication (there are a number of different devices that require different administration techniques)

We will also educate you about things in the environment that can trigger asthma and what you can do about them.

Additionally, you will be given a written asthma management/action plan. The management plan tells you what medicines to give everyday to keep your child's asthma under control when your child is doing well. it will also give you an action plan specifying what to do if your child develops symptoms.

The action plan is very important because. It can be scary for parents when their child has symptoms, especially trouble breathing. Some parents may feel like they don't know what to do when that happens. The action plan will spell out exactly what to do.

If your child requires further testing, we will explain what tests we are recommending. If your child is scheduled for testing, you should call us the following day to let us know the test was done and we will call you back to review the results and discuss any action that needs to be taken.

Please be sure to ask any questions that you may have. You should also let us know about other caregivers who will need instructions — especially about giving medications — such as grandparents, child care providers, school nurse or coach.

Follow-up appointment

After the visit we will send a letter and a copy of your child's asthma management/action plan to your child's primary care provider, so that he or she will be fully informed about your child's office visit and our recommendations.

Before you leave at the end of your appointment, we will give you prescriptions for the medicines we recommend and let you know how to obtain any special equipment, such as a spacer or nebulizer. We will let you know when and if we would like to see your child back for follow-up. You can make a follow-up appointment and arrangements for any testing with the clinic coordinator before you leave the office.

Follow-up is important. We want to know how you and your child are managing and if your child's asthma is better or not so that we can reevaluate and make any necessary changes to your child's asthma management/action plan and medications.

At your follow-up visit, we try to make sure that you see the same Asthma Program team members as you did on your first visit. During the appointment, we will conduct another spirometry breathing test and compare the results to the testing done at the last visit so we can see how your child is doing.