Quality standard

Quality statement 1: Objective tests to support diagnosis

Quality statement 1: Objective tests to support diagnosis

Quality statement

People aged 5 years and over with suspected asthma have objective tests to support diagnosis. [2013, updated 2018]

Rationale

Asthma can be misdiagnosed, which means that people with untreated asthma are at risk of an asthma attack, and people who do not have asthma receive unnecessary drugs. Following taking an initial history and assessment, objective tests can help healthcare professionals to diagnose asthma correctly in people over 5 years. There is no single objective test to diagnose asthma and a combination of tests will be needed for most people. The basis on which a diagnosis of asthma is made should be recorded in the person's medical records. Children under 5 are unable to perform objective tests and should be treated with inhaled corticosteroids based on the recommendations on pharmacological management in children under 5 in the BTS, NICE, SIGN guideline on asthma, until objective tests can be attempted when they reach 5 years.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that healthcare professionals are trained and competent to carry out and interpret objective tests to support diagnosis of asthma.

Data source: Local data collection, for example, training records and competency assessments.

Process

Proportion of people aged 5 years and over with newly diagnosed asthma who have a record of the objective tests used to support diagnosis.

Numerator – the number in the denominator who have a record of the objective tests used to support diagnosis.

Denominator – the number of people aged 5 years and over with newly diagnosed asthma.

Data source: NHS England's Quality and Outcomes Framework indicator AST011 reports data on the percentage of patients with a diagnosis of asthma with a record of objective tests.

Outcome

Prevalence of asthma.

Data source: NHS England's Quality and Outcomes Framework indicator AST001 reports data on the number of patients with asthma.

What the quality statement means for different audiences

Service providers (such as GP practices, community health services and hospitals) ensure that processes are in place for people aged 5 years and over with suspected asthma to have objective tests to support diagnosis. Service providers ensure that healthcare professionals are trained and competent in performing and interpreting objective tests, and that processes are in place to record the basis for a diagnosis of asthma.

Healthcare professionals (such as doctors, nurses and pharmacists) are aware of local arrangements for accessing objective tests for asthma and ensure that people aged 5 years and over with suspected asthma have objective tests to support diagnosis. Healthcare professionals record the basis for a diagnosis of asthma.

Commissioners commission services that ensure that people aged 5 years and over with suspected asthma have objective tests to support diagnosis.

People aged 5 years and over with suspected asthma have tests to confirm if they have asthma. An accurate diagnosis will make sure they get the treatment they need.

Definitions of terms used in this quality statement

Objective tests to diagnose asthma

Tests carried out to help determine whether a person has asthma, the results of which are not based on the person's symptoms, for example, tests to measure lung function or evidence of inflammation. There is no single objective test to diagnose asthma. Objective tests should be performed in accordance with algorithm A objective tests for diagnosing asthma in adults and young people (aged over 16 years) with a history suggesting asthma and algorithm B objective tests for diagnosing asthma in children aged 5 to 16 with a history suggesting asthma in the BTS, NICE, SIGN guideline on asthma. [Adapted from BTS, NICE, SIGN guideline on asthma, recommendations 1.2.1 to 1.2.9 and expert opinion]

Suspected asthma

A potential diagnosis of asthma based on symptoms that have not yet been confirmed with objective tests. [Expert opinion]

Equality and diversity considerations

If a child is unable to perform objective tests when they are aged 5, healthcare professionals should try doing the tests again every 6 to 12 months until satisfactory results are obtained. [BTS, NICE, SIGN guideline on asthma, recommendation 1.3.2]

Some people with learning disabilities or mental health problems may need additional support to help them to perform objective tests to diagnose asthma.