Quality Standards
Issued: February 2013
QS25

Quality standard for asthma

Introduction and overview

This quality standard covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older. For more information see the scope for this quality standard.

Introduction

Asthma is a long-term condition that affects the airways in the lungs in children, young people and adults. Classic symptoms include breathlessness, tightness in the chest, coughing and wheezing. The goal of management is for people to be free from symptoms and able to lead a normal, active life. This is achieved partly through treatment, tailored to the person, and partly by people getting to know what provokes their symptoms and avoiding these triggers as much as possible. The causes of asthma are not well understood, so a cure is not usually possible, although this can sometimes be achieved in occupational asthma. Occupational factors account for about 1 in 6 cases of asthma in adults of working age[1].

In the UK, 5.4 million people are currently receiving treatment for asthma, 1.1 million of whom are children[2]. Asthma is the most common long-term medical condition, and 1 in 11 children has it. There are around 1000 deaths a year from asthma, about 90% of which are associated with preventable factors. Almost 40% of these deaths are in people under 75. Asthma is responsible for large numbers of accident and emergency department attendances and hospital admissions. Most admissions are emergencies and 70% may have been preventable with appropriate early interventions[3].

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

NHS outcomes framework 2013–14

Domain1: Preventing people from dying prematurely

Overarching indicators

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare
i) Adults
ii) Children and young people (placeholder)

Improvement areas

Reducing premature mortality from the major causes of death

1.2 Under 75 mortality rate for respiratory disease

Domain 2: Enhancing quality of life for people with long-term conditions

Overarching indicator

2 Health-related quality of life for people with long-term conditions

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Reducing time spent in hospital by people with long-term conditions

2.3i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

2.3ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Domain 3: Helping people to recover from episodes of ill health or following injury

Overarching indicator

3b Emergency readmissions within 30 days of discharge from hospital

Domain 4: Ensuring that people have a positive experience of care

Overarching indicators

4a i Patient experience of primary care – GP services

4b Patient experience of hospital care

Public health outcomes framework 2013–16

Domain 4: Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities.

Indicator

4.7 Mortality from respiratory disease

4.11 Emergency readmissions within 30 days of discharge from hospital (placeholder)

Overview

The quality standard for asthma requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole asthma care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to adults, young people and children with asthma.

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in diagnosing and managing asthma in adults, young people and children should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.