
Patients aged eight and over diagnosed as having asthma from
1 April 2006
(One of these codes added 3 months before diagnosis,
or after)
Spirometry codes for Asthma
- 33G1. Spirometry reversibility positive
- 33H1. Positive reversibility test to salbutamol
- 33I1. Positive reversibility test to ipratropium bromide
- 33J1. Positive reversibility test to a combination of salbutamol and ipratropium
bromide
- 33K1. Positive reversibility test to corticosteroids
- 663J. Airways obstruction reversible
- 8HRC. Referral for spirometry
745D4 Post bronchodilator spirometry
PEFR codes
- 339A. Peak flow rate before bronchodilation
- 339B. Peak flow rate after bronchodilation
- 339c. Peak expiratory flow rate pre steroids
- 339d. Peak expiratory flow rate post steroids
- 339g. Serial peak expiratory flow rate
- 339n. Serial peak expiratory flow rate abnormal
- 66YX. Peak expiratory flow rate monitoring
- 66YY. Peak expiratory flow rate monitoring using diary
66Yc. Number of consecutive days at less than 80% peak expiratory flow rate
33950 Diurnal variation of peak expiratory flow rate

Spirometry Exception Codes
33720 Unable to perform spirometry
8I2j. Spirometry contraindicated
8I3b. Spirometry test declined
8I6L. Spirometry not indicated
Asthma Diagnosis Codes
- H33.. Asthma
- H330. Extrinsic (atopic) asthma
- H3300 Extrinsic asthma without status asthmaticus
- H3301 Extrinsic asthma with status asthmaticus
- H330z Extrinsic asthma NOS
- H331. Intrinsic asthma
- H3310 Intrinsic asthma without status asthmaticus
- H3311 Intrinsic asthma with status asthmaticus
- H331z Intrinsic asthma NOS
- H332. Mixed asthma
H333. Acute exacerbation of asthma (v28)
- H334. Brittle asthma
- H335. Chronic asthma with fixed airflow obstruction
H33z. Asthma unspecified
- H33z0 Status asthmaticus NOS
H33z1 Asthma attack
- H33z2 Late-onset asthma
- H33zz Asthma NOS
H3120 Chronic asthmatic bronchitis
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173A. Exercise induced asthma (v27.1)
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Asthma Resolved (After diagnosis)
- 21262 Asthma resolved
- 212G. Asthma resolved
Exclusion codes (Every 12 months)
- 9hA.. Exception reporting: asthma quality indicators
- 9hA1. Excepted from asthma quality indicators: Patient unsuitable
- 9hA2. Excepted from asthma quality indicators: Informed dissent
- 9OJ2. Refuses asthma monitoring
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Asthma 002.1 Rational
There is no single infallible test to confirm a diagnosis of asthma. On the
basis of the clinical history and examination it will be possible to decide
if the probability of asthma is high, intermediate or low and the aim of investigations
is to demonstrate objectively the presence of variability in order to support
or reject the diagnosis. There are Read codes for ‘suspected asthma’ and ‘suspected
respiratory condition’ which may be used whilst investigations are undertaken
and the diagnosis confirmed.
Further information about the diagnosis of asthma is provided in the BTS-SIGN
asthma guideline. It is crucial that diagnostic spirometry is performed to published
quality standards.
Asthma history
The diagnosis of asthma is suspected when a patient presents a history of variable
wheeze, chest tightness, shortness of breath or cough, commonly triggered by
viral infections and/or allergy and/or exercise. A personal or family history
of atopy (including positive skin prick testing) increases the probability of
asthma.
Practices may wish to confirm a diagnosis of asthma for those patients who
were diagnosed with asthma in previous QOF years before they were eight years
of age. Once the patient turns eight it is acceptable to re-examine the diagnosis
using tests of variability or reversibility. In those patients who are not receiving
long-term antiinflammatory therapy they should be treated as a new presenting
case and the diagnosis re-evaluated.
If asthma is probable
In symptomatic patients airway obstruction may be demonstrated by spirometry
(FEV1/FVC ratio <0.7) and (if available) nitric oxide can be used to measure
airway inflammation.
Variability of symptoms and/or lung function may be demonstrated in a reversibility
test or may occur spontaneously over time in response to triggers or to treatment;
demonstration of variability supports the diagnosis of asthma and may be conveniently
achieved in primary care in a number of ways:
- Spirometry may be used to demonstrate reversibility in symptomatic patients
with demonstrated airflow obstruction. A bronchodilator reversibility test
can be performed with inhaled or nebulised short acting beta agonist and if
the obstruction reverses then asthma is confirmed. Significant reversibility
is a change in FEV1 >12 per cent and 200 ml (the absolute change is scaled
down according to predicted FEV1 in children). Increases of >400 mls are strongly
suggestive of asthma. Lower levels of bronchodilator reversibility may be
demonstrated in some patients
with COPD Normal spirometry, however, does not exclude asthma; indeed
the variable nature of asthma means that many of the milder patients seen
in primary care will be asymptomatic at the time of the lung function test
and will have completely normal lung function with no reversibility at the
time of testing.
- Variability of PEF. This may be demonstrated by monitoring diurnal, or day
to day variation (recorded twice a day for two weeks using the same peak flow
meter) and/or demonstrating an increase after therapy (15 minutes after short-acting
bronchodilator, after six weeks of inhaled steroids, or up to two weeks after
oral steroid treatment) and/or after exposure to triggers (such as exercise,
laughter, or allergens). Significant variability is a change of 20 per cent
and >60 l/min (the absolute change is scaled down in children to 20 per cent
of predicted PEF). PEF are effort dependent and patients need to be taught
the correct technique.
- Variability in objective measures of asthma symptom scores (e.g. RCP questions,
ACQ, ACT questionnaire, or GINA Control Tool) Symptom scores may be particularly
useful in patients unable to undertake accurate serial measures of lung function
and to aid clinical interpretation of lung function (e.g. normal lung function
in a symptomatic patient might suggest an alternative cause for the symptoms).
A trial of treatment, with repeated lung function measurements and/or symptoms
scores over time will demonstrate objective improvement of symptoms and lung
function in people with asthma, thereby confirming the diagnosis. In children
it is particularly important to reduce and stop treatment to exclude spontaneous
improvement.
If the probability of asthma is intermediate
Spirometry is the key investigation for distinguishing obstructive and restrictive
respiratory conditions and will determine subsequent investigations.More specialist
assessment may be required in those in whom the diagnosis is still unclear,
which may include assessment of airway inflammation (e.g. nitric oxide measurement),
bronchial hyper-responsiveness testing and consideration of alternative diagnoses.
It is recommended that children with combined food allergy and asthma and any
patient with late onset asthma where there is a suspicion of an occupational
cause are referred for specialist assessment.
If another diagnosis is more likely
If an alternative diagnosis is suspected, investigation and management are
to follow guidelines for that condition.
Co-morbidity: asthma and COPD
A proportion of patients with asthma will have both asthma and COPD e.g. they
have airway obstruction that does not reverse to normal but also have substantial
reversibility
Asthma 002.2 Reporting and verification
See indicator wording for requirement criteria.
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Prepared By Jean Keenan