Hippo Labs uses the official NHS England QOF Business Rules to help practices manage asthma care systematically — from diagnosis and register validation to annual monitoring and smoking-status recording.
💬 Just a reminder: these indicators aren’t clinical guidelines — they’re operational definitions used for QOF measurement. They determine which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The Asthma Register (AST005)
At the heart of the asthma indicators is a register of active patients who require ongoing asthma monitoring. This is the foundation for all other indicators.
Patients appear on the register if they:
Are aged 6 years or older, and
Have an unresolved asthma diagnosis, and
Have been issued asthma-related medication within the past 12 months
Patients are excluded if they:
Have an asthma resolved code after their latest diagnosis, or
Have had no asthma medication in the last 12 months
✅ In short: only patients with current, treated asthma should appear on the register.
🩺 The Indicators
These indicators apply only to patients on the asthma register. Together, they measure the completeness, safety, and quality of asthma care provided throughout the year.
🔁 AST007 — Annual Asthma Review
Measures:
% of patients on the asthma register who have had a complete asthma review in the last 12 months.
A complete review must include:
✅ Assessment of asthma control
✅ Recording of number of exacerbations (within 1 month before or on the review date)
✅ Check of inhaler technique
✅ Written personalised action plan on the same day as the review
Exclusions (Personalised Care Adjustments):
Unsuitable for review
Declined asthma monitoring or care
Two coded care invitations ≥7 days apart with no attendance (removed for payment only — Hippo continues to flag for recall)
Newly diagnosed within the last 3 months
Newly registered within the last 3 months
⚠️ Common pitfalls:
Review coded but missing the written plan
Exacerbation recorded outside the 1-month window
Missing inhaler technique code
Review components recorded on separate dates
Using free-text instead of SNOMED codes
✅ In short: all four elements must be coded within 12 months, with the action plan and review on the same day.
🚭 AST008 — Smoking or Smoke-Exposure Recording (Under 19s)
Measures:
% of patients aged 19 or under on the asthma register with a record of smoking status or exposure to second-hand smoke in the past 12 months.
Counts as complete if any of these are coded:
Smoking status
Exposure to second-hand smoke
No exposure to second-hand smoke
Exclusions:
Declined to state smoking status
Unsuitable or declined review
Newly diagnosed/registered (within 3 months)
Two invitations sent with no attendance (removed for payment only)
⚠️ Common pitfalls:
Recording smoking status once in childhood — must be updated annually
Using social-history notes instead of coded entries
Forgetting to record “no exposure” when appropriate
✅ In short: every young person with asthma should have an up-to-date smoking or smoke-exposure record each year.
🧪 AST012 — Objective Testing for New Diagnoses (NEW in v50.1)
Measures:
% of patients diagnosed on or after 1 April 2025 with objective evidence confirming the diagnosis within 3 months before → 3 months after diagnosis.
For adults (≥17 years):
Full blood count (FBC)
FeNO test
Spirometry (bronchodilator reversibility)
Peak-flow variability (if spirometry unavailable)
Bronchial challenge test
For children (5–16 years):
FeNO test
Spirometry (bronchodilator reversibility)
Peak-flow variability (if spirometry unavailable)
Skin-prick test to house-dust mite
Total IgE + blood eosinophil count
Bronchial challenge test
Exclusions:
Unsuitable or declined testing
Service unavailable (spirometry / FeNO codes)
Newly diagnosed within last 3 months
⚠️ Common pitfalls:
Spirometry done but not linked to the diagnosis code
Objective test performed outside the 3-month window
Missing FeNO or no coded evidence of reversibility
Confusing this with annual reviews — applies only to new diagnoses
✅ In short: every new asthma diagnosis from April 2025 onwards must include at least one coded objective test within 3 months before or after diagnosis.
🧩 Putting It All Together
Indicator | Focus | What It Shows | What to Do |
AST007 | Annual review | Completeness of ongoing asthma management | Recall for full review + ensure all four elements coded |
AST008 | Smoking status (U19s) | Risk-factor documentation in young asthmatics | Record smoking or exposure status yearly |
AST012 | Diagnostic quality | Objective evidence confirming new diagnoses | Ensure spirometry + another test coded in window |
🌟 Why This Matters
Following these indicators helps practices:
Maintain a validated, up-to-date asthma register
Deliver structured, complete annual reviews
Ensure accurate diagnosis and coding consistency
Demonstrate QOF compliance and support proactive care
✅ In short: the Asthma Indicators ensure accurate registers, complete reviews, and clear evidence of safe, high-quality asthma management across the whole practice population.
📚 Sources
NHS England QOF Business Rules v50.1 (Asthma, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)