Quality standard

Quality statement 3: Monitoring asthma control

Quality statement 3: Monitoring asthma control

Quality statement

People with asthma have their asthma control monitored at every asthma review. [2013, updated 2018]

Rationale

Monitoring of asthma control at every asthma review will identify if control is suboptimal. If asthma is uncontrolled, the person should have an assessment to identify possible reasons for this, including suboptimal adherence and inhaler technique as well as other relevant factors, before their treatment is adjusted. Support and education can be provided to improve adherence and inhaler technique. Monitoring asthma control and addressing any problems identified will improve quality of life and reduce the risk of serious asthma attacks and hospital admissions.

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 people with asthma have their asthma control monitored at every asthma review.

Data source: Local data collection, for example, service protocol.

Process

a) Proportion of people with asthma who had an asthma review within the past 12 months.

Numerator – the number in the denominator who had an asthma review within the past 12 months.

Denominator – the number of people with asthma.

Data source: NHS England's Quality and Outcomes Framework indicator AST007 includes data on asthma reviews.

b) Proportion of asthma reviews that include monitoring of asthma control.

Numerator – the number in the denominator that include monitoring of asthma control.

Denominator – the number of asthma reviews.

Data source: Local data collection, for example, audit of patient health records. NHS England's Quality and Outcomes Framework indicator AST007 includes data on exacerbations as part of annual asthma reviews.

Outcome

a) Proportion of people with asthma prescribed more than 2 short-acting beta2 agonist (SABA) reliever inhalers within the past 12 months.

Data source: Local data collection, for example, electronic prescribing data. The NHS Business Services Authority Respiratory Dashboard includes data on the proportion of patients prescribed preventer inhalers without antimuscarinics who were also prescribed 6 or more SABA inhalers for a rolling 12-month period. The Pharmaceutical Services Negotiating Committee's pharmacy quality scheme collects data on referrals for an asthma review for people with asthma dispensed 3 or more short-acting bronchodilator inhalers without any corticosteroid inhaler within a 6‑month period.

b) Rate of hospital attendance or admission for asthma attack.

Data source: NHS Digital's Hospital Episode Statistics includes data on admissions and A&E attendances for asthma attack.

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 with asthma to have their asthma control monitored at every asthma review. Service providers ensure that if uncontrolled asthma is identified, processes are in place for adherence and inhaler technique and other relevant factors to be assessed before treatment is adjusted. Service providers ensure that staff are trained to use the tools and tests needed to monitor asthma control and to assess adherence and inhaler technique.

Healthcare professionals (such as doctors, nurses, healthcare assistants and pharmacists) monitor asthma control at every asthma review. If uncontrolled asthma is identified, they assess adherence and inhaler technique and other relevant factors before adjusting treatment.

Commissioners commission services that monitor asthma control at every asthma review. Commissioners ensure that tools, such as a validated questionnaire and testing, are available for monitoring asthma control.

People with asthma have their asthma control checked when they have a review of their asthma. If their asthma is not well controlled, they get support to make sure they are using their medicines correctly, for example, a check of how they are using their inhaler. They are also asked about other factors that may be relevant such as smoking and exposure to air pollution, indoor mould or other risks at work. If this doesn't help, they may have their medicines or inhaler changed to help prevent asthma attacks.

Definitions of terms used in this quality statement

Monitoring asthma control

Consider using a validated questionnaire, such as the Asthma Control Questionnaire, Asthma Control Test or the Childhood Asthma Control Test, to monitor asthma control. Consider FeNO monitoring for adults with asthma. Do not use peak expiratory flow monitoring (PEF) to assess asthma control unless there are person-specific reasons for doing so, for example when PEF measurement is part of the personalised asthma action plan. [BTS, NICE, SIGN guideline on asthma, recommendations 1.5.2 to 1.5.4]

Asthma review

Any asthma review, including review after an asthma attack and annual asthma review. [Expert opinion]

Equality and diversity considerations

Healthcare professionals using a validated questionnaire to monitor asthma control should ensure it is provided in a suitable format to meet individual needs. People with a learning disability or low literacy levels may need additional support to ensure that they understand what is being asked and can take part in the discussion.