Asthma management
Add the diagnosis
All Medical History Records in Descending order Where READ_CODE = "2126200 "
Last 1 Medical History Records Where READ_CODE = "H33"
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<Asthma>
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<Asthma Nos>
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<Asthma Unspecified>
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<Extrinsic (atopic) Asthma>
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<Intrinsic Asthma>
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<Asthma Resolved>
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<Serial peak flow>
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<reversiblity>
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Exception Codes
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Remember to include a valid reason for exception reporting the patient
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Last 1 Medical History Records Where READ_CODE = "9hA1.00 " OR READ_CODE = "9hA2.00 "
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<Informed disent>
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<Patient Unsuitable>
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<Refuses Asthma Monitoring>
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Smoking Status & Advice
Last 1 Smoking Records Where READ_CODE = "1371.00 " OR READ_CODE = "137R.00 " OR READ_CODE = "137S.00 "
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<Never Smoked>
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<Current smoker>
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<Ex Smoker>
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Last 1 Medical History Records Where READ_CODE = "8HTK.00 "
Last 1 Medical History Records Where READ_CODE = "8CAL.00 "
Many young people start to smoke at an early age. It is therefore required that smoking status is recorded annually for the 14 to 19 age group.
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<Refer to Stop Smoking Clinic>
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<Smoking Cessation Advice>
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Peak Flow / Spirometry / Reversibility / Variability
Accurate diagnosis is vital in order to avoid both under treated symptoms and innapropriate treatment as a result of over diagnosis. Objective measurement of variability spontaneously over time or in response to therapy is fundamental to the diagnosis of asthma and may be achieved in primary care by serial peak flow measurements.
Significant variabilty in peak flow is defined asa change of at least 20% with a minimun change of 60l/min. It may be demonstrated by by monitoring diurnal variation, demonstrating an increase in peak flow after therapy (15mins after short acting bronchodilator, after 6 weeks inhaled steroids or 2 weeks of oral steroids) or a reduction in peak flow after exercise.
Spirometry may be used to confirm variability if there is >15% or >200ml change in FEV1
Repeated normal readings in a symptomatic patient cast doubt on the diagnosis although the natural variability means that many patients with asthma will not have significant variability at any given time. Confirmation of the diagnosis may need further readings.
If in doubt consider alternative diagnosis or refer for specialist assessment.
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Lung Function>1D 008vVForced Vital Capacity 008tVForced Expiratory Volume in 1 sec 008uVFEV1/FVC 007PVLung Func before bronchodilation 007QVLung Func after bronchodilation 009JVAirway Reversibility 007TVPF current
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Serial peak flow measurement in surgery or at home using a diary can be used to demonstrate variability
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Last 1 PF current Records Where READ_CODE = "339g.00 "
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<Serial peak flow measurement>
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Inhaler Technique
Inhalers should only be prescribed after patients have received training in the use of the device and have demonstrated satisfactory technique.
Inhaler technique should be reviewed regularly especially if control is inadequate.
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Last 1 Inhaler ability Records Where READ_CODE = "663H.00 " OR READ_CODE = "663I.00 "
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<Inhaler Technique Good>
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<Inhaler Technique Poor>
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Symptoms
QoF suggests using three RCP questions asan effective way of assessing symptoms.:
1. Have you had difficulty sleeping because of your asthma symptoms (including cough)?
2. Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
3. Has your asthma interfered with your usual activities eg housework, work, school work etc?
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Asthma Exersize Codes
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<Increasing Exercise Wheeze>
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<Limiting Activities>
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<severly restricts exercise>
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<Never restricts exercise>
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<limits walking up hill or stairs>
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<limits walking on the flat>
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<Not Limiting Activites>
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<Restricts Exercise>
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<Sometimes restricts exercise>
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Asthma sleep codes
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<Disturbing Sleep>
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<Causing Night Waking>
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<Disturbs sleep weekly>
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<Disturbs sleep frequently>
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<not disturbing sleep>
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<Never disturbs sleep>
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<causes night symptoms 1 to 2 times per month>
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<Night time symptoms>
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Asthma Daytime symptoms
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<Daytime symptoms>
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<never causes daytime symtoms>
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<causes daytime symptoms 1 to 2 times per month>
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<causes daytime symptoms 1 to 2 times per week>
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<causes daytime symptoms most days>
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Personalised Asthma Plan
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Although there is ggod evidence on the use of personalised asthma plans in secondary care, there is very limited evidence in primary care. Practices may wish to follow the advice of the BTS / SIGN guideline and offer a personalised asthma action plan.
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Last 1 Current asthma status Records Where READ_CODE = "663U.00 "
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<Asthma Managment Plan Given>
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Last 1 Medical History Records Where READ_CODE = "66Y5.00 "
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<Change in Asthma Management Plan>
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Immunisations
Last 1 Immunisations Records Where READ_CODE = "68NE.00 "
Last 1 Drug Allergies & Adverse Reactions Records Where READ_CODE = "8I2F.00 " OR READ_CODE = "U60K400 " OR READ_CODE = "14LJ.00 "
Last 1 Immunisations Records Where READ_CODE = "65E..00 "
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<Declined>
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<Contraindicated>
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<Adverse Reaction>
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<Allergy>
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Last 1 Immunisations Records Where READ_CODE = "6572.00 " OR READ_CODE = "6572000 "
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<Pneumococcal Immunisation Given>
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Last 1 Immunisations Records Where READ_CODE = "68NX.00 "
Last 1 Drug Allergies & Adverse Reactions Records Where READ_CODE = "8I2E.00 " OR READ_CODE = "U60J800 " OR READ_CODE = "14LR.00 "
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<Declined>
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<Contraindicated>
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<Adverse Reaction>
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<Allergy>
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Asthma Annual Review
An asthma annual review must include:
1. Assessment of symptoms using three RCP questions
2. Measurement of peak flow
3. Assessment of inhaler technique
4. Consider personalised asthma plan
Update existing recall for asthma annual review where possible or create a new recall if none exists.
Delete all old asthma recalls.
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Last 1 Asthma consultation Records Where READ_CODE = "66YJ.00 "
Recall for asthma annual review
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If there is more than one recall showing please delete all old recalls
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All Recall Records in Descending order Where READ_CODE2 = "66YJ.00 "