AST012 - Newly diagnosed asthma with tests
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.
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).
This indicator was released in the contract year 2025/26 with version 50 of the Business Rules for QOF, replacing AST011
Indicator definition
Indicator ID | Description |
AST012 | The percentage of patients with a diagnosis of asthma on or after 1 April 2025 with a record of an objective test between 3 months before or 3 months after diagnosis. |
How is this different to AST011?
The business rules have been updated to reflect the new NICE guidelines, removing the need for spirometry and including other diagnostic tests such as FBC blood test (for eosinophils), bronchial challenge tests and skin prick tests (for under 16s only) as the diagnostic tests to diagnose asthma. The diagnostic tests which count are different for patients over and under 16 years old. The time period for the diagnostic tests to be done has been reduced from 6 months after diagnosis to 3 months after diagnosis. You used to get a window for newly registered patients who were diagnosed before joining the practice in AST011 - this has been removed in AST012.
What do the business rules mean?
What makes a patient eligible?
In order to be included in the denominator (patients who are eligible for the indicator), patients must:
- be on the Asthma register
- have been diagnosed with asthma for the first time on or after 1st April 2025
This backstop date tends to move forward every 2 years, meaning it isn't expected to change until at least 1st April 2027.
How to achieve the indicator
This depends on whether patients are under or over 16.
Over 16
Patients must have had one of the following in the period spanning the 93 days (3 months) before or after the earliest unresolved asthma diagnosis
- a full blood count (for eosinophils)
- have a record of FeNO testing
- had a bronchodilator reversibility with spirometry (BDR) test
- had a peak expiratory flow rate (PEFR) variability test (only if spirometry not available is also coded)
- had a bronchial challenge test
Under 16
Patients must have had one of the following in the period spanning the 93 days (3 months) before or after the earliest unresolved asthma diagnosis
- have a record of FeNO testing
- had a bronchodilator reversibility with spirometry (BDR) test
- had a peak expiratory flow rate (PEFR) variability test (only if spirometry not available is also coded)
- had a skin prick test to house dust mite
- a total IgE level and blood eosinophil count
- had a bronchial challenge test
The business rules define an under 16 as somebody who will still be under 17 at the end of the contract year. This means a 16 year old patient who has a skin prick test (only applicable to under 16s), but turns 17 before the end of the year will drop out of the numerator unless one of the 'over 16' tests is also completed.
What will remove patients from eligibility?
- Patients from whom asthma quality indicator care was unsuitable in the contract year
- Patients who chose not to receive monitoring in the contract year
- Patients who have chosen not to receive any asthma quality indicator care in the contract year
- Patients who have been invited twice between 3 months before and 3 months after the asthma diagnosis
- Patients who were diagnosed in the last 3 months of the contract year
- 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.FBC codes (FBC_COD)
SNOMED code | SNOMED code description |
1022431000000105 | Haemoglobin estimation |
1022451000000103 | Red blood cell count |
1022491000000106 | Mean corpuscular volume |
1022541000000102 | Total white cell count |
1107511000000100 | Mass concentration of haemoglobin in blood |
1107531000000108 | Substance concentration of haemoglobin in blood |
1110441000000100 | White blood cell count in blood |
1491000237105 | Mean corpuscular volume of erythrocytes in blood |
375911000119106 | Differential count of white blood cells by automated method |
Note that none of the codes in FBC_COD relate to Eosinophils. These codes are effectively markers as the expectation may be for eosinophils to be reported on an FBC panel result.
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 |
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 |
Peak expiratory flow rate (PEFR) variability codes (PEFRVAR_COD)
SNOMED code | SNOMED code description |
| 401199000 | Percentage of peak expiratory flow rate variability |
429745009 | Diurnal variation of peak expiratory flow rate |
Diagnostic Spirometry unavailable codes (SPIRPCASU_COD)
SNOMED code | SNOMED code description |
1109901000000102 | Diagnostic spirometry quality indicator service unavailable codes |
This code my be used in conjunction with PEFR variability. It does not have to be on the same date, but must be coded on or after the new asthma diagnosis, even if the PEFR was done in the 93 days prior to diagnosis.
Bronchial challenge test codes (BRONCCHALENG_COD)
SNOMED code | SNOMED code description |
15435001 | Inhalation bronchial challenge testing |
165011001 | Bronchial provocation test |
252520007 | Methacholine challenge |
Skin prick test for house dust mite codes (SKINTEST_COD)
SNOMED code | SNOMED code description |
165004000 | Allergy skin test positive |
232350006 | Allergy to dust mite protein |
Total IgE level codes (IGE_COD)
SNOMED code | SNOMED code description |
1020431000000106 | Total immunoglobulin E level |
963641000000109 | Measurement of total immunoglobulin E concentration in serum specimen |
Codes for asthma quality indicator care unsuitable for patient (ASTPCAPU_COD)
SNOMED code | SNOMED code description |
717291000000103 | Excepted from asthma quality indicators - patient unsuitable |
Patients who have chosen not to receive any asthma quality indicator care (ASTPCADEC_COD)
SNOMED code | SNOMED code description |
716491000000100 | Excepted from asthma quality indicators - informed dissent |
Patients who have been invited twice for an asthma review at least 7 days apart (ASTINVITE_COD)
SNOMED code | SNOMED code description |
1110841000000103 | Quality and Outcomes Framework asthma quality indicator-related care invitation |
185731000 | Asthma monitoring call first letter |
185732007 | Asthma monitoring call second letter |
185734008 | Asthma monitoring call third letter |
185735009 | Asthma monitoring call verbal invite |
185736005 | Asthma monitoring call telephone invite |
92161000000104 | Quality and Outcomes Framework asthma quality indicator-related care invitation using preferred method of communication |
928451000000107 | Asthma monitoring invitation short message service text message |
928511000000107 | Asthma monitoring invitation email |
959401000000101 | Asthma monitoring short message service text message first invitation |
959421000000105 | Asthma monitoring short message service text message second invitation |
959441000000103 | Asthma monitoring short message service text message third invitation |
Codes indicating the patient has chosen not to receive asthma monitoring (ASTMONDEC_COD)
SNOMED code | SNOMED code description |
763221007 | Asthma monitoring declined |
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