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 suboptimal asthma control is identified, the person should have an assessment to identify possible reasons for this, including adherence and inhaler technique, 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

Structure

a) Evidence that tools, such as a validated questionnaire, are used locally for monitoring asthma control in adults.

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

b) Evidence that spirometry or peak flow variability testing are used locally for monitoring asthma control in people aged 5 and over.

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

c) 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: Local data collection, for example, audit of patient heath records.

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 heath records.

Outcome

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

Data source: Local data collection, for example, electronic prescribing data. The community pharmacy quality payments scheme collects data on referrals for an asthma review for people with asthma dispensed more than 6 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 asthma control is suboptimal, processes are in place for adherence and inhaler technique 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 control is suboptimal they assess adherence and inhaler technique before adjusting treatment.

Commissioners (clinical commissioning groups and NHS England) commission services that monitor asthma control at every asthma review. Commissioners ensure that tools, such as a validated questionnaire, and spirometry or peak flow variability 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. If this doesn't help, they may have their medicines or inhaler changed to help prevent asthma attacks.

Source guidance

Asthma: diagnosis, monitoring and chronic asthma management (2017) NICE guideline NG80, recommendations 1.14.1 and 1.14.3

Definitions of terms used in this quality statement

Monitoring asthma control

Consider using a validated questionnaire, such as the Asthma Control Questionnaire or Asthma Control Test, to monitor asthma control in adults. Asthma control should be monitored in people aged 5 and over using either spirometry or peak flow variability testing.

[NICE's guideline on asthma, recommendations 1.14.2 and 1.14.3]

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.