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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

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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

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:

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