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The UK's primary care sustainability network

1. Improving the diagnosis of suspected asthma

Understanding how an asthma diagnosis is made for patients at your practice will help you to identify areas for improvement. There may be variation depending on who the patient consults with and what diagnostic services are available.

Coding suspected asthma is important so that patients can be followed up appropriately. The SNOMED code is: 394967008 Suspected asthma (situation).

If you have a new diagnosis of asthma there are complex rules around this for QoF purposes. See this helpful support article.

The process

Step 1: Find out how patients in your practice are diagnosed with asthma.

Ask clinicians individually or discuss at a practice meeting.

What confirmatory investigations are available in the practice or locally to support diagnosis and how quickly can these be accessed?

What do clinicians do if they see a patient who they suspect has asthma and is symptomatic and needs treatment at time of presentation?

Do clinicians code ‘suspected asthma’ in the notes?

What is the process for follow up of suspected asthma?

What happens when letters come through from A&E suggesting a patient was seen and they may have asthma. How is this coded and followed up?

Step 2: Use this information to make improvements

Based on the information you obtain, think about whether any changes or improvements are needed. If you aren’t the respiratory lead at your surgery, you could start by discussing this with them. If there is no respiratory lead, could you become one?

Some ideas for improvements are shown below, but you are likely to identify others.

Idea 1: Arrange a clinical update session

This could improve clinicians’ confidence in diagnosis or update them on current guidelines. There are also videos available in the education section to support this.

Resources:

Idea 2: Write or update the asthma diagnosis protocol

A protocol can help reduce variation in practice. You may want to include information on:

Clinical signs and symptoms that make a diagnosis of asthma more likely

Coding of suspected asthma

Treatment if person is symptomatic at presentation

Which confirmatory investigations (Spirometry/FeNO/Peak flow variation) depending on availability

Who will follow up patients with suspected asthma and how

The process for coding and follow up when letters come through from A&E suggesting a patient was seen and they may have asthma.

Idea 3: Remind clinicians to code “suspected asthma”

An agenda item in a practice meeting or notification could improve coding of suspected asthma, allowing for better follow-up. The SNOMED code is: 394967008 Suspected asthma (situation).