How is this different to AST011?

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 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

1. a full blood count (for eosinophils)
   
2. have a record of FeNO testing
   
3. had a bronchodilator reversibility with spirometry (BDR) test
   
4. had a peak expiratory flow rate (PEFR) variability test (only if spirometry not available is also coded)
   
5. 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

1. have a record of FeNO testing
2. had a bronchodilator reversibility with spirometry (BDR) test
3. had a peak expiratory flow rate (PEFR) variability test (only if spirometry not available is also coded)
4. had a skin prick test to house dust mite
5. a total IgE level and blood eosinophil count
6. 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?

1. Patients from whom asthma quality indicator care was unsuitable in the contract year
   
2. Patients who chose not to receive monitoring in the contract year
   
3. Patients who have chosen not to receive any asthma quality indicator care in the contract year
   
4. Patients who have been invited twice between 3 months before and 3 months after the asthma diagnosis
5. Patients who were diagnosed in the last 3 months of the contract year
6. Patients who were newly registered with the practice in the last 3 months of the contract year

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)

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)

Skin prick test for house dust mite codes (SKINTEST_COD)

Total IgE level codes (IGE_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)