Skip to main content
Back to the Project Library

Improving Asthma Diagnosis

This project is likely to take:
<10 hours for the initial search and clinical training session.


This project is best carried out by a GP (qualified or trainee), a nurse or other allied healthcare professional

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Well-Led (Environmental Sustainability)
  • Safe (Medicines Optimisation)
  • Effective (Delivering Evidenced-Based Care and Treatment)

On this page

The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Reduces risks related to undertreatment such as asthma attacks
  • Reduces risks from unnecessary treatment
Project benefits for Your Practice

Benefits for Your Practice

  • Understanding how an asthma diagnosis is made for patients at your practice will help you to identify areas for improvement.
  • Reduced workload from improved asthma care for patients with asthma and reduced prescription requests from those who do not have asthma.
Project benefits for The Planet

Benefits for The Planet

  • Reduces unnecessary prescriptions of SABA inhalers

Opportunity for improvement

  • Patients who present with possible symptoms of asthma may have been commenced on a SABA inhaler, and if follow-up does not occur, these patients are at risk of undertreatment and asthma attacks.
  • Coding 'suspected asthma' is important so that patients can be followed up appropriately. The SNOMED code is: 394967008
  • The search for this project is limited to patients aged 5yrs and over, to exclude patients who have received SABA inhalers for viral wheeze where it may be too early for an asthma diagnosis to be considered.
  • Your search may reveal patients who are likely to have other diagnoses, which will need confirmation and coding.
  • You might like to make a SMART goal for this project, e.g. within 6 months, develop a protocol for asthma diagnosis and follow up.

How to carry out this project

  1. Find out how asthma diagnoses are made in your practice.

    Discuss with colleagues and review local guidance. Identify:

    • what they do if treatment is needed at first presentation
    • which diagnostic tests are available
    • which codes are used (suspected asthma/asthma)
    • the follow-up process, both within primary care and after hospital assessment or admission

    Engage the whole team in this process, particularly practice nurses and clinicians who frequently do asthma reviews. Discuss whether there are barriers to diagnosis.

    Coding ‘suspected asthma’ is important so that patients can be followed up appropriately. If inadequate follow-up occurs, patients may keep the suspected asthma code. It is important to resolve these codes to ensure that patients receive appropriate asthma treatment and follow-up, or an alternative diagnosis.

    Consider whether changes or improvements are needed. Is there a respiratory lead? If not, could you become one?

  2. Search for patients aged 5 and over who have been prescribed SABA in the last 12 months AND do not have a diagnosis of asthma AND do not have a diagnosis of COPD.

    Check if any asthma diagnostic tests have been done for these patients.

  3. Review the patient notes.

    Find out:

    • Which diagnosis was suspected?
    • Have they received follow-up from the initial appointment where SABA was prescribed?
    • Has the diagnosis been made but not coded?
    • Have they had any exacerbations that suggest they may need urgent review?

    Use our data collection table to record this information and your subsequent action.

    Resource: Data Collection Table

    View

  4. Update the coding.

    Where the correct diagnosis has been made but not coded correctly, update the coding.

  5. Organise a team education/clinical update session.

    Ensure everyone involved in asthma care at your practice is invited. Consider doing this at PCN level for increased coverage. Present the data obtained from steps 1-3

    Obtain feedback from the team regarding the current diagnostic process and available tests. Would it be helpful to write a practice or PCN level pathway for diagnosis that is adjusted to the diagnostic tests available?

    Resources:

    Improving Asthma Reviews

    Objective test algorithm for people aged 16+

    Objective test algorithm for people 5-16

    Peak flow variability calculator

  6. Invite all patients with an unclear diagnosis for a review.

    Use the data collection table to stratify the risk and prioritise those presenting with one or more exacerbations in the last year. The table has drop-down pick lists in the cells to make data collection easier.

    Give patients a timeframe to respond (e.g. 6 weeks). Check for non-responders following this time period and repeat contact. Consider an alternative method (such as letter or phone call).

  7. SMS Template

    Resource: Consultation invitation for patients on SABA-only therapy without a diagnosis

    Your doctor or nurse needs to review your inhaler medication to check you are on the best treatment for your symptoms. Please make a routine appointment.

  8. Letter Template

    Resource: Consultation invitation for patients on SABA-only therapy without a diagnosis

    Dear Patient, We would like to invite you to make an appointment to discuss your inhaler medication. These medications are usually given for symptoms like cough, wheezing or difficulty in breathing. These symptoms can be due to short-term problems like chest infections, but they may also be due to long-term conditions like asthma and COPD (chronic obstructive pulmonary disease). Your doctor or nurse needs to check if you are still having symptoms and whether you need any further investigations. This will help us to ensure you receive the best possible treatment. Please contact us to make a routine appointment, Many thanks, [Practice name/ lead clinician]

  9. After conducting your team education session and clinical reviews repeat the search in step 2 to assess change.

Top tip

Ensure all clinicians use the code 'suspected asthma' and that there is a clear process for follow up.

If follow up is done by a different clinician to the one who first suspected the diagnosis, ensure 'suspected asthma' is on the appointment so that they can be followed up in case of DNA.

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could upscale this project by taking it to your PCN pharmacy team to implement across all practices in your PCN. 

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the cost and carbon savings and other probable benefits. This project may help with CQC evidence submission (see disclaimers).

Get your certificate

More project guides

View all