Quality standard

Quality statement 4: Advice for people with chronic respiratory or cardiovascular conditions

Quality statement 4: Advice for people with chronic respiratory or cardiovascular conditions

Quality statement

Children, young people and adults with chronic respiratory or cardiovascular conditions are given advice at routine health appointments on what to do when outdoor air quality is poor.

Rationale

Periods of poor air quality are associated with adverse health effects, including asthma attacks, reduced lung function, and increased mortality and admissions to hospital. Providing advice to children, young people and adults with chronic respiratory or cardiovascular conditions (and their families or carers, if appropriate) at routine health appointments will support self-management, improve their awareness of how to protect themselves when outdoor air quality is poor and prevent their condition escalating.

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

a) Evidence that healthcare professionals carrying out routine health appointments with children, young people and adults with chronic respiratory or cardiovascular conditions are aware of the advice they should provide on what to do when outdoor air quality is poor.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, training records.

b) Evidence of local processes to ensure that children, young people and adults with chronic respiratory or cardiovascular conditions attending routine health appointments are given advice on what to do when outdoor air quality is poor.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, service protocols.

Process

Proportion of children, young people and adults with chronic respiratory or cardiovascular conditions attending a routine health appointment that were given advice on what to do when outdoor air quality is poor.

Numerator – the number in the denominator that were given advice on what to do when outdoor air quality is poor.

Denominator – the number of children, young people and adults with chronic respiratory or cardiovascular conditions attending a routine health appointment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, audit of patient records.

Outcome

a) Level of awareness among children, young people and adults with chronic respiratory or cardiovascular conditions on what to do when outdoor air quality is poor.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, surveys of children, young people and adults with chronic respiratory or cardiovascular conditions.

b) Rate of hospital attendance or admission for respiratory or cardiovascular exacerbations.

Data source: NHS Digital's Hospital Episode Statistics includes data on admissions and A&E attendances for asthma attacks, acute chronic obstructive pulmonary disease exacerbations, heart attacks, strokes, heart failure and angina attacks.

What the quality statement means for different audiences

Service providers (such as general practices, community health services, hospitals and community pharmacies) ensure that healthcare professionals are aware that information on air quality is available, what it means and what actions are recommended. Service providers ensure that processes are in place to provide advice on what to do when outdoor air quality is poor to children, young people and adults with chronic respiratory or cardiovascular conditions (and their families or carers, if appropriate) at routine health appointments. Providers ensure that advice includes how to find out when outdoor air quality is expected to be poor such as from the Department for Environment, Food and Rural Affairs' Daily Air Quality Index.

Healthcare professionals (such as doctors, nurses, healthcare assistants and pharmacists) provide advice on what to do when outdoor air quality is poor to children, young people and adults with chronic respiratory or cardiovascular conditions who are attending a routine health appointment (and their families and carers, if appropriate). They also provide information on how to find out when outdoor air quality is expected to be poor, for example using the Department for Environment, Food and Rural Affairs' Daily Air Quality Index.

Commissioners commission services that provide advice on what to do when outdoor air quality is poor to children, young people and adults (and their families and carers, if appropriate) at routine health appointments.

People with long-term breathing or heart conditions (and their family and carers, if appropriate) are given advice at routine health appointments on what to do when outdoor air quality is poor and how to find out when it is likely to be poor.

Definitions of terms used in this quality statement

Routine health appointments

Annual reviews and other appointments focused on supporting management of chronic respiratory or cardiovascular conditions. [Expert opinion]

Advice on what to do when outdoor air quality is poor

Advice should include how to minimise exposure to outdoor air pollution and manage any related symptoms such as:

  • Avoiding or reducing strenuous activity outside, especially in highly polluted locations such as busy streets, and particularly if experiencing symptoms such as sore eyes, a cough or sore throat.

  • Adults over 17 who are using an inhaled corticosteroid in a single inhaler could have an increased dose for 7 days. It should be clear how and when to do this, and what to do if symptoms do not improve.

  • People with asthma should contact a healthcare professional for a review if their asthma control deteriorates.

  • Closing external doors and windows facing a busy street at times when traffic is heavy or congested to help stop highly polluted air getting in.

[NICE's guideline on air pollution: outdoor air quality and health, recommendation 1.7.7; BTS, NICE, SIGN guideline on asthma, recommendations 1.14.4 and 1.14.5; and the Department for Environment, Food and Rural Affairs' Daily Air Quality Index]

Poor outdoor air quality

The Daily Air Quality Index describes air pollution on a scale of 1 to 10 and is divided into 4 bands from low to very high. Health effects may occur when air pollution is moderate (4 to 6), high (7 to 9) or very high (10). [The Department for Environment, Food and Rural Affairs' Daily Air Quality Index]