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6635. Increasing exercise wheeze
663P. Asthma limiting activities
663P0 Asthma limits activities 1 to 2 times per month
663P1 Asthma limits activities 1 to 2 times per week
663P2 Asthma limits activities most days
663Q. Asthma not limiting activities
663e. Asthma restricts exercise
663e0 Asthma sometimes restricts exercise
663e1 Asthma severely restricts exercise
663f. Asthma never restricts exercise
663w. Asthma limits walking up hills or stairs
663x. Asthma limits walking on the flat
663N. Asthma disturbing sleep
663N0 Asthma causing night waking
663N1 Asthma disturbs sleep weekly
663N2 Asthma disturbs sleep frequently
663O. Asthma not disturbing sleep
663O0 Asthma never disturbs sleep
663r. Asthma causes night symptoms 1 to 2 times per month
66YP. Asthma night-time symptoms
66Ys. Asthma never causes night symptoms
66Yq. Asthma causes night time symptoms 1 to 2 times per week
66Yr. Asthma causes symptoms most nights
663q. Asthma daytime symptoms
663s. Asthma never causes daytime symptoms
663t. Asthma causes daytime symptoms 1 to 2 times per month
663u. Asthma causes daytime symptoms 1 to 2 times per week
663v. Asthma causes daytime symptoms most days
H3120 Chronic asthmatic bronchitis
173A. Exercise induced asthma (v27.1)
Structured care has been shown to produce benefits for patients with asthma. The recording of morbidity, PEF levels, inhaler technique and current treatment and the promotion of self-management skills are common themes of good structured care. SIGN/BTS proposes a structured system for recording inhaler technique, morbidity, PEF levels, current treatment and asthma action plans.
The BTS/SIGN guideline http://www.sign.ac.uk/pdf/qrg101.pdf proposes a structured system for recording inhaler technique, morbidity, PEF levels, current treatment and asthma action plans.
The clinical guideline recommends the use of standard questions for the monitoring of asthma. Proactive structured review, rather than opportunistic or unscheduled review, is associated with reduced exacerbation rate and fewer days lost from normal activity..
The QOF now explicitly requires that the following RCP questions are used as an effective way of assessing symptoms:
“In the last month:
The questions must be asked at the same time and as part of the review. A response of 'No' to all questions is consistent with well-controlled asthma.
If the asthma appears to be uncontrolled, the following are to be managed appropriately before increasing asthma therapy:
• smoking behaviour (because smoking interferes with asthma control)
• poor inhaler technique
• inadequate adherence with regular preventative asthma therapy
There is increasing evidence to support personalised asthma action plans in adults with persistent asthma. Contractors may wish to follow the advice of the BTS/SIGN guideline and offer a personalised asthma action plan to patients.
Peak flow is a valuable guide to the status of a patient’s asthma especially during exacerbations. However, it is much more useful if there is a record of their best peak flow (that is, peak flow when they are well). Many guidelines for exacerbations are based on the ratio of current to best peak flows. For patients aged 19 or over no particular time limit is needed for measuring best peak flow. However in view of the reduction in peak flow with age, it is recommended that the measurement be updated every few years. For patients aged 18 or under the peak flow will be changing; therefore it is recommended that the best peak flow be re-assessed annually. Inhaler technique is to be reviewed regularly. The BTS/SIGN clinical guideline emphasises the importance of assessing ability to use inhalers before prescribing and regularly reviewing technique, especially if control is inadequate. Inhalers are to be prescribed only after patients have received training in the use of the device and have demonstrated satisfactory technique. Reassess inhaler technique as part of their structured asthma review.
During an asthma review the following takes place:
If the asthma appears to be uncontrolled, follow the additional steps outlined above.
See indicator wording for requirement criteria.
The Business Rules require that contractors code the review and the responses to the three RCP questions separately and on the same day in order to meet the requirements of this indicator.
Prepared By Jean Keenan