An integrated approach to asthma services is vital, says NICE in new quality standard

NICE has today (21 February) published a new quality standard on the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or NICE accredited sources, and apply right across the NHS in England.

The new quality standard on asthma consists of a prioritised set of specific, concise and measurable statements that, when delivered collectively, should contribute to improving the effectiveness, quality, safety and experience of care for people with the condition.

The quality standard contains 11 statements. These include:

  • Adults with new onset asthma are assessed for occupational causesi.
  • People with asthma receive a structured review at least annually.
  • People aged 5 years or older presenting to a healthcare professional with a severe or life-threatening acute exacerbation of asthma receive oral or intravenous steroids within 1 hour of presentationii.
  • People with difficult asthma are offered an assessment by a multidisciplinary difficult asthma service.

Asthma is a long-term, inflammatory disorder affecting the airways. It is characterised by symptoms including breathlessness, wheezing and coughing, particularly at night. Allergic asthma is the most common type of asthma and is triggered by immunoglobulin E (IgE) antibodies produced in response to environmental allergens such as pollen, dust mites, or moulds. There are currently more than 5.4 million people in the UK being treated for asthma; about 1.1 million of these are children. There were 1,131 deaths from asthma in the UK in 2009 (12 were children aged 14 years or under), which is, on average, 3 people per day or 1 person every 8 hoursiii.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: "Asthma is a common lung disorder in the UK and can have a significant, negative effect on a person's quality of life. NICE is pleased to be publishing this new quality standard on asthma, which contains eleven statements that will contribute to improving the quality and experience of care for those with the condition."

Professor Sue Hill and Dr Robert Winter, joint National Clinical Directors for Respiratory Disease, said: "Asthma is an area where we can, and should, be doing so much more. This new NICE quality standard is a great step forward as it reinforces those areas where best practice and guidelines should be applied.

"If we address the areas of care highlighted in this quality standard, then we should see significant improvements in outcomes for people living with asthma and their overall quality of life."

Emily Humphreys, Head of Policy and Public Affairs at Asthma UK, which has endorsed the quality standard, said: "We're delighted that a quality standard is now in place for asthma. This will really help to improve the quality of care provided for one of the most common long-term conditions - so it's no exaggeration to say that if this is successful, it could change millions of lives.

"We're particularly pleased to see the inclusion of personal asthma action plans. People who have an action plan are four times less likely to need to be admitted to hospital, but only a tiny proportion of people with asthma are currently offered one. Making sure this is implemented will be the next key test of asthma care in the NHS."

Dr Penny Woods, Chief Executive of the British Lung Foundation, which has endorsed the quality standard, said: "With mortality 50% higher than the EU average, and hospital admissions significantly more common than elsewhere in the developed world, most people working in respiratory disease today will recognise that there is considerable scope for improving asthma care in this country. We hope that, by outlining priority areas for quality improvement, this new quality standard document will mark a significant step towards the kind of world-class care everyone working in the industry wants for the four and a half million people living with asthma across England.”


Notes to Editors

References and explanation of terms

i. Occupational asthma is the only form of asthma that can potentially be cured by removing the person from exposure to the trigger.

ii. The use of early steroids may contribute to reducing the need for hospital admission, preventing relapse in symptoms, reducing mortality and the need for β2 agonist therapy. Beta 2 adrenergic receptor agonists are a class of drugs used to treat asthma and other pulmonary diseases.

iii. Asthma UK.

About the quality standard

1. The new quality standard on asthma is available on the NICE website from 00:01 hrs on Thursday 21 February.

Related NICE guidelines and quality standards

2. Patient experience in adult NHS services NICE quality standard (2012)

3. Chronic obstructive pulmonary disease (COPD) NICE quality standard (2011)

4. Smoking cessation NICE quality standard (in development)

5. Medicines optimisation NICE quality standard (referred for development)

6. NICE clinical guideline on asthma (in development)

Guidance source used to develop the quality standard

7. British guideline on the management of asthma British Thoracic Society and Scottish Intercollegiate Guidelines Network clinical guideline 101 (2008, updated 2011; NICE accredited)

About NICE quality standards

8. NICE quality standards aim to help commissioners, health, social care and public health professionals and service providers improve the quality of care that they deliver.

9. NICE quality standards help demonstrate delivery of high quality care in a particular high-priority improvement area through measurable statements. There is an average of 6-8 statements in each quality standard.

10. Quality standards are derived from evidence-based guidance, such as NICE guidance or NICE accredited sources, and are produced collaboratively with the NHS, social care or public health organisations, along with their partner organisations, patients, carers and service users.

11. NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health, social care and public health professionals can use quality standards to help deliver excellent care and treatment.

12. NICE quality standards are not requirements or targets, but the healthcare system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

13. Quality standard topics are formally referred to NICE by the NHS Commissioning Board, (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for non-health areas such as social care. Further information on the NHS Commissioning Board can be found on their website.

14. More information on NICE quality standards.

About NICE

15. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

16. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies -guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
  • social care- the Health and Social Care Act (2012) sets out a new responsibility for NICE to develop guidance and quality standards for social care. To reflect this new role, from 1 April 2013 NICE will be called the National Institute for Health and Care Excellence (NICE) and it will become a Non-Departmental Public Body.

17. NICE produces standards for patient care:

  • quality standards- these describe high-priority areas for quality improvement in a defined care or service area
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
  • CCG Outcomes Indicator Set (formerly known as COF) - NICE develops the potential clinical health improvement indicators to ensure quality of care for patients and communities served by the clinical commissioning groups (CCGs).

18. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 20 February 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.