Adult Asthma Report 5 Coles Lane, Oakington, Cambridge, CB24 3BA

The adult asthma report only concerns patients aged ≥ 18 years Practice Overview The adult asthma report only concerns patients aged ≥ 18 years Asthma Patient: asthma QOF diagnosis code & no asthma resolved code & issued respiratory therapy in last 2 years Page 1

Contents Patient Demographics Asthma Diagnosis Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Recommendations Page 2

Age Distribution Co-morbidities Smoking Status Patient Demographics Contents Patient Demographics Age Distribution Co-morbidities Smoking Status Asthma Diagnosis Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Recommendations Page 3

The adult asthma report only concerns patients aged ≥ 18 years Patient Demographics Age Distribution The adult asthma report only concerns patients aged ≥ 18 years Page 4

Co-morbidities Patient Demographics Page 5 Rhinitis: Read code entry in last 2 years or nasal steroid therapy in last year GERD, Depression/Anxiety: Read code entry in last 2 years Page 5

Smoking Status Patient Demographics Page 6 Smoking status is obtained from patient questionnaires where available or from routine practice data Page 6

Confirming Asthma Diagnosis Potentially Undiagnosed Patients Contents Patient Demographics Asthma Diagnosis Confirming Asthma Diagnosis Potentially Undiagnosed Patients Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Recommendations Page 7

Confirming Asthma Diagnosis Asthma Diagnosis: asthma QOF diagnosis code Excluding Patients ≤ age 7 years: QOF AST002 Page 8

Potentially Undiagnosed Patients Asthma Diagnosis Potentially Undiagnosed Patients LRTIs: measured as occurrence of 3 or more LRTIs in last 2 years Asthma Diagnosis: asthma QOF diagnosis code Page 9

Control Status from RCP Data, SABA use, etc. Contents Patient Demographics Asthma Diagnosis Asthma Control Control Status from RCP Data, SABA use, etc. Smoking, Rhinitis and Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Recommendations Page 10

Measuring Asthma Control Information from three sources is used to assess patients’ asthma GINA control score* and other measures of asthma control: Practice recorded data from RCP3 questions, ACT questions, reliever use and PEFR. Data from patient questionnaire responses: RCP3 questions, reliever use, etc. Quantity of SABA prescriptions, which can be used as proxy measure of asthma control. Global INitiative for Asthma (GINA) control score can be calculated from RCP3 questions responses, reliever use and lung function data Page 11

Asthma Control Status: RCP Data* RCP data is obtained from patient questionnaires where available or from routine practice data Page 12

Asthma Control Status: SABA as Proxy* Where RCP Data Unknown Quantity of short acting bronchodilators issued is used as proxy measure of asthma control where RCP data is not available Page 13

Smoking and Asthma Control* OPC Service Control status is based on RCP data obtained from patient questionnaires where available or from routine practice data Page 14

Rhinitis and Asthma Control* OPC Service Control status is based on RCP data obtained from patient questionnaires where available or from routine practice data Page 15

Management by BTS Steps Contents Patient Demographics Asthma Diagnosis Asthma Control Asthma Management Management by BTS Steps Risk and Exacerbations Adherence and Asthma Reviews Recommendations Page 16

BTS/SIGN Step Guidelines: Adults Asthma Management BTS/SIGN Step Guidelines: Adults Page 17

Management by BTS Step: Adults Asthma Management Management by BTS Step: Adults Page 18

Asthma Control by BTS Step: RCP Data* Asthma Management Asthma Control by BTS Step: RCP Data* OPC Service Control status is based on RCP data obtained from patient questionnaires where available or from routine practice data Page 19

Asthma Control by BTS Step: SABA Proxy* Asthma Management Asthma Control by BTS Step: SABA Proxy* OPC Service Quantity of short acting bronchodilators issued is used as proxy measure of asthma control where RCP data is not available Page 20

High Risk Patients Exacerbations Patient Demographics Asthma Diagnosis Contents Patient Demographics Asthma Diagnosis Asthma Control Asthma Management Risk and Exacerbations High Risk Patients Exacerbations Adherence and Asthma Reviews Recommendations Page 21

High Risk Asthma Patients Risk and Exacerbations High Risk Asthma Patients High Risk: 2 or more exacerbations per year Very High Risk: 2 or more exacerbations per year & at BTS Step 4 or 5 Page 22

Exacerbation* by BTS Step Risk and Exacerbations Exacerbation* by BTS Step OPC Service Exacerbations: exacerbation Read code entry or patient reported exacerbation & hospitalisations & number of courses of oral steroids in last 12 months Page 23

Acute Oral Steroid Use* by BTS Step Risk and Exacerbations Acute Oral Steroid Use* by BTS Step OPC Service Courses of acute oral steroids issued in the last 12 months Page 24

Adherence to Inhaled Steroids Inhaler Technique Asthma Reviews Contents Patient Demographics Asthma Diagnosis Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Adherence to Inhaled Steroids Inhaler Technique Asthma Reviews Recommendations Page 25

Adherence to Inhaled Steroids* Adherence and Asthma Reviews Adherence to Inhaled Steroids* Number of scripts in last 1 year Number of scripts expected based on prescribed dosage Adherence = X 100 Inhaled steroids include ICS and combination therapies Page 26

Inhaler Technique* and Asthma Control Status Adherence and Asthma Reviews Inhaler Technique* and Asthma Control Status OPC Service Inhaler technique review provided in last 12 months and recorded by Read code entry Page 27

Asthma Reviews and Self-Management Plans* Adherence and Asthma Reviews Asthma Reviews and Self-Management Plans* Asthma reviews and self-management plans provided in last 12 months and recorded by Read code entry Page 28

Asthma Reviews* by BTS Step Adherence and Asthma Reviews Asthma Reviews* by BTS Step Asthma reviews provided in last 12 months and recorded by Read code entry Page 29

Therapy Recommendations Management Recommendations Contents Patient Demographics Asthma Diagnosis Asthma Control Asthma Management Risk and Exacerbations Adherence and Asthma Reviews Recommendations Therapy Recommendations Management Recommendations Page 30

PLEASE NOTE Recommendations The practice report recommendations have been grouped into ‘Therapy Recommendations’ and ‘Management Recommendations’. Please consider both groups of recommendations together, as a holistic approach is vital for effective patient care and optimising patient outcomes. Patients covered within each recommendation and the patient questionnaire responses can be viewed on your asthma patient level reports, through the OPC Tools application on your practice computer. Please refer to the ‘Viewing Patient Reports’ user-guide to assist you in this regard. Alternatively, please contact the OPC service delivery team for assistance. Optimum Patient Care 5 Coles Lane, Oakington, Cambridge, CB24 3BA Tel: 01223 967 855 email: services@optimumpatientcare.org Page 31

Therapy Recommendations Please review patient adherence/concordance and inhaler technique before stepping up therapy Adapted from BTS/SIGN and Global Initiative for Asthma (GINA) guidelines Page 32

Your Practice Therapy Recommendations Page 33

Management Recommendations Adapted from BTS/SIGN and Global Initiative for Asthma (GINA) guidelines Page 34

Your Practice Management Recommendations Page 35