What do the business rules mean?

What makes a patient eligible?

1. be on the Asthma register
   
2. have been diagnosed with asthma for the first time on or after 1st April 2023
   

This backstop date tends to move forward every 2 years, meaning it isn't expected to change until at least 1st April 2025.

What will remove patients from eligibility?

1. Those who are diagnosed within 6 months of the end of the contract year
   
2. New patients registered within 6 months of the end of the contract year who already have a diagnosis of asthma without the required tests
   
3. Where spirometry is unavailable
   
4. Patient is new to the practice with previously diagnosed asthma and spirometry unavailable is coded within 6 months of the registration date
   
5. Where FENO testing is unavailable
   
6. Patients who are new to the practice with previously diagnosed asthma and FENO testing unavailable is coded within 6 months of the registration date
   
7. Patients for whom spirometry was unsuitable
   
8. Patients who are new to the practice with previously diagnosed asthma and spirometry unsuitable is coded within 6 months of the registration date
   
9. Patients from whom asthma quality indicator care was unsuitable in the contract year
   
10. Patients who declined a spirometry procedure
    
11. Patients who are new to the practice with previously diagnosed asthma and spirometry declined is coded within 6 months of the registration date
    
12. Patients who chose not to receive monitoring in the contract year
    
13. Patients who have chosen not to receive any asthma quality indicator care in the contract year
    
14. Patients who have been invited twice between 3 months before and 6 months after the asthma diagnosis, or 6 months after the registration date (for new patients)
15. Patients who were diagnosed in the last 3 months of the contract year
    
16. Patients who were newly registered with the practice in the last 3 months of the contract year

If a patient achieves the indicator at any point during the year, any exclusions that have also been added are ignored.

SNOMED codes used in this indicator

The codes referenced in this article are taken from the NHS Technology Reference Update Distribution (TRUD).  Not all of these may be present or selectable in all clinical systems.

Spirometry codes for asthma (ASTSPIR_COD)

SNOMED code	SNOMED code description
170627008	Airways obstruction reversible
314979004	Spirometry reversibility test
314981002	Spirometry reversibility positive
391118006	Positive reversibility test to salbutamol
391119003	Positive reversibility test to ipratropium bromide
391121008	Positive reversibility test to a combination of salbutamol and ipratropium bromide
391122001	Positive reversibility test to corticosteroids
702540003	Referral for spirometry reversibility test
767906009	Post bronchodilator spirometry
774951000000101	Post bronchodilator spirometry
882591000000103	Referral for spirometry reversibility testing

Codes indicating FeNO test performed (FENO_COD)

SNOMED code	SNOMED code description
1201788001	Volume fraction of nitric oxide in exhaled air
444642008	Measurement of expired nitric oxide

Peak expiratory flow rate (PEFR) codes (PEFR_COD)

Diagnostic Spirometry unavailable codes (SPIRPCASU_COD)

Fractional exhaled nitric oxide test service unavailable codes (FENOPCASU_COD)

Codes for spirometry testing unsuitable for patient (SPIRPU_COD)

Codes for asthma quality indicator care unsuitable for patient (ASTPCAPU_COD)

Codes indicating the patient has chosen not to receive asthma monitoring (ASTMONDEC_COD)