AST012 - Newly diagnosed asthma with tests
The information contained within this article is from version 50 of the Business Rules for Quality and Outcomes Framework (QOF).
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.
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 20235 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 <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 (if spirometry is not available)
- had a bronchial challenge test (codes currently unavailable)
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 (if spirometry is not available)
- had a skin prick test to house dust mite (codes currently unavailable)
- a total IgE level (codes currently unavailable) and blood eosinophil count
- had a bronchial challenge test (codes currently unavailable)
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 (observable entity) |
1022451000000103 | Red blood cell count (observable entity) |
1022491000000106 | Mean corpuscular volume (observable entity) |
1022541000000102 | Total white cell count (observable entity) |
1107511000000100 | Mass concentration of haemoglobin in blood (observable entity) |
1107531000000108 | Substance concentration of haemoglobin in blood (observable entity) |
1110441000000100 | White blood cell count in blood (observable entity) |
1491000237105 | Mean corpuscular volume of erythrocytes in blood (observable entity) |
375911000119106 | Differential count of white blood cells by automated method (observable entity) |
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) codes (PEFR_COD)
SNOMED code | SNOMED code description |
| 1084021000000103 | Number of consecutive days at less than 80% peak expiratory flow rate (observable entity) |
134432000 | Recorded/predicted peak expiratory flow rate ratio (observable entity) |
165871000000103 | Peak expiratory flow rate measured using EN 13826 device (observable entity) |
18491006 | Peak expiratory flow rate (observable entity) |
251936000 | Best ever peak expiratory flow rate (observable entity) |
251939007 | Single peak expiratory flow rate (observable entity) |
251940009 | Serial peak expiratory flow rate (observable entity) |
271507006 | Peak flow rate after bronchodilation (observable entity) |
271529005 | Peak flow rate before bronchodilation (observable entity) |
29893006 | Peak expiratory flow measurement (procedure) |
313232000 | Peak expiratory flow rate after bronchodilation (observable entity) |
313276007 | Peak expiratory flow rate before bronchodilation (observable entity) |
37494006 | Increased peak expiratory flow rate (finding) |
401004000 | Peak expiratory flow rate monitoring (regime/therapy) |
401011001 | Peak expiratory flow rate monitoring using diary (regime/therapy) |
401014009 | Peak expiratory flow rate pre steroids (observable entity) |
401015005 | Peak expiratory flow rate post steroids (observable entity) |
401163005 | Percentage of best ever peak expiratory flow rate (observable entity) |
401199000 | Percentage of peak expiratory flow rate variability (observable entity) |
407668008 | Serial peak expiratory flow rate abnormal (finding) |
414883002 | Number of consecutive days at less than 80 percent peak expiratory flow rate (finding) |
429745009 | Diurnal variation of peak expiratory flow rate (observable entity) |
716760001 | Assessment using European Union Scale for Peak Expiratory Flow Rate for adults (procedure) |
716761002 | Assessment using European Union Scale for Peak Expiratory Flow Rate for children (procedure) |
7206008 | Decreased peak expiratory flow rate (finding) |
763131000000100 | Peak expiratory flow rate after exercise (observable entity) |
878870000 | Peak expiratory flow rate after exercise (observable entity) |
980161000000106 | European Union Scale for Peak Expiratory Flow Rate - Adult (observable entity) |
980181000000102 | European Union Scale for Peak Expiratory Flow Rate - Children (observable entity) |
Diagnostic Spirometry unavailable codes (SPIRPCASU_COD)
SNOMED code | SNOMED code description |
1109901000000102 | Diagnostic spirometry quality indicator service unavailable codes |
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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