Table of Contents

Metadata

Name Asthma
Type Disease or Syndrome
Group Respiratory
Data Sources UK Biobankprimary carehospital admissions datamortality data
Clinical Terminologies Read, SNOMED CT, ICD-10
Validation cross-source, casenote, aetiology, prognosis
Valid Event Data Range 01/01/2001 to 31/12/2019
Sex Female/Male
Authors Eleanor L Axson, Jennifer K Quint
Agreement Date 16 Dec 2019
Modified Date 16 Dec 2019
Version Revision 1

Definitions

UK Biobank

In Biobank, we utilised the self-report codes per the Definitions of Asthma for UK Biobank Phase 1 Outcomes Adjudication. You can find more information here: http://biobank.ndph.ox.ac.uk/showcase/showcase/docs/alg_outcome_asthma.pdf

field_id lookup_id lookup_value
20002 1111 Asthma

Primary Care

Read v2 Code SNOMED CT Concept ID SNOMED CT Description ID Description Quality and Outcomes Framework Read Codes 2017/18 Validated Specific Asthma Read Codes Nissen et al. 2017 Validated Non-Specific Asthma Read Codes Nissen et al. 2017
H330.11 389145006 1483199016 Allergic asthma Y Y
H33zz12 389145006 1483199016 Allergic asthma NEC Y Y
H33..00 195967001 301485011 Asthma Y Y
H33zz00 708038006 3032734012 Asthma NOS Y Y
H33z100 708038006 3032734012 Asthma attack Y Y
H33z111 195967001 301485011 Asthma attack NOS Y Y
H33z.00 195967001 301485011 Asthma unspecified Y Y
H334.00 225057002 338238011 Brittle asthma Y Y
H33..11 195967001 301480018 Bronchial asthma Y Y
H335.00 866881000000101 2240591000000119 Chronic asthma with fixed airflow obstruction Y Y
H312000 195949008 301450011 Chronic asthmatic bronchitis Y Y
H33zz11 31387002 52467014 Exercise induced asthma Y Y
173A.00 31387002 52467014 Exercise induced asthma Y Y
H330.00 389145006 1493645010 Extrinsic (atopic) asthma Y Y
H330z00 424643009 2648327010 Extrinsic asthma NOS Y Y
H330111 708093000 3083642013 Extrinsic asthma with asthma attack Y Y
H330100 1086701000000102 2722231000000112 Extrinsic asthma with status asthmaticus Y Y
H330000 63088003 104872017 Extrinsic asthma without status asthmaticus Y Y
H330.13 233683003 350153016 Hay fever with asthma Y Y
H330011 233683003 350153016 Hay fever with asthma Y Y
H331.00 266361008 396114013 Intrinsic asthma Y Y
H331z00 266361008 396114013 Intrinsic asthma NOS Y Y
H331111 708094006 3032866010 Intrinsic asthma with asthma attack Y Y
H331100 1086711000000100 2722261000000119 Intrinsic asthma with status asthmaticus Y Y
H331000 12428000 21390015 Intrinsic asthma without status asthmaticus Y Y
H331.11 233679003 350148014 Late onset asthma Y Y
H33z200 233679003 350148014 Late-onset asthma Y Y
H330.14 233683003 350154010 Pollen asthma Y Y
H33z011 708090002 3033029011 Severe asthma attack Y Y
H33z000 734904007 3511368015 Status asthmaticus NOS Y Y
H3B..00 10692761000119107 3046456013 Asthma-chronic obstructive pulmonary disease overlap syndrome Y
H332.00 195977004 301509017 Mixed asthma Y
66YC.00 390921001 1484953014 Absent from work or school due to asthma Y
H333.00 708038006 3032747019 Acute exacerbation of asthma Y
1780.00 407674008 2159273015 Aspirin induced asthma Y
663j.00 312453004 456163018 Asthma - currently active Y
663m.00 708373002 3034176014 Asthma accident and emergency attendance since last visit Y
66YJ.00 394700004 1488421017 Asthma annual review Y
663t.00 370202007 1208954011 Asthma causes daytime symptoms 1 to 2 times per month Y
663u.00 370203002 1208955012 Asthma causes daytime symptoms 1 to 2 times per week Y
663v.00 370204008 1208956013 Asthma causes daytime symptoms most days Y
663r.00 370205009 1208957016 Asthma causes night symptoms 1 to 2 times per month Y
66Yq.00 771901000000100 1722421000000110 Asthma causes night time symptoms 1 to 2 times per week Y
66Yr.00 771941000000102 1722501000000119 Asthma causes symptoms most nights Y
663N000 170632009 264541019 Asthma causing night waking Y
8CR0.00 736056000 3516216012 Asthma clinical management plan Y
1O2..00 401193004 1780388018 Asthma confirmed Y
38DT.00 763077003 3637798014 Asthma control questionnaire Y
8794.00 182727003 282489019 Asthma control step 1 Y
8795.00 182728008 282490011 Asthma control step 2 Y
8796.00 182729000 282491010 Asthma control step 3 Y
8797.00 182730005 282492015 Asthma control step 4 Y
8798.00 182731009 282493013 Asthma control step 5 Y
38DL.00 443117005 2839948011 Asthma control test Y
663q.00 373899003 1212342016 Asthma daytime symptoms Y
663N.00 170631002 264540018 Asthma disturbing sleep Y
663N200 170634005 264543016 Asthma disturbs sleep frequently Y
663N100 170633004 264542014 Asthma disturbs sleep weekly Y
66YK.00 394701000 1488422012 Asthma follow-up Y
663P.00 170637003 264546012 Asthma limiting activities Y
663P000 771981000000105 1722581000000112 Asthma limits activities 1 to 2 times per month Y
663P100 772011000000107 1722651000000119 Asthma limits activities 1 to 2 times per week Y
663P200 772051000000106 1722731000000116 Asthma limits activities most days Y
663x.00 370206005 1208958014 Asthma limits walking on the flat Y
663w.00 370207001 1208959018 Asthma limits walking up hills or stairs Y
663U.00 406162001 2157868010 Asthma management plan given Y
8B3j.00 394720003 1488436019 Asthma medication review Y
9OJA.11 270442000 405054019 Asthma monitored Y
663..11 275908000 411877015 Asthma monitoring Y
66YR.00 401183006 1780379010 Asthma monitoring by doctor Y
66YQ.00 401182001 1780378019 Asthma monitoring by nurse Y
663s.00 370208006 1208960011 Asthma never causes daytime symptoms Y
66Ys.00 473391009 2956621015 Asthma never causes night symptoms Y
663O000 170636007 264545011 Asthma never disturbs sleep Y
663f.00 170658009 264569010 Asthma never restricts exercise Y
66YP.00 395022009 1488722011 Asthma night-time symptoms Y
663e.00 170655007 264566015 Asthma restricts exercise Y
66Yp.00 754061000000100 1658781000000113 Asthma review using Roy Colleg of Physicians three questions Y
661M100 811921000000103 2117771000000117 Asthma self-management plan agreed Y
661N100 810901000000102 2115631000000117 Asthma self-management plan review Y
663e100 170657004 264568019 Asthma severely restricts exercise Y
663V.00 170642006 264551018 Asthma severity Y
663e000 170656008 264567012 Asthma sometimes restricts exercise Y
663n.00 370226009 1208977011 Asthma treatment compliance satisfactory Y
663p.00 370225008 1208976019 Asthma treatment compliance unsatisfactory Y
178A.00 340891000000106 1739131000000111 Asthma trigger - airborne dust Y
1786.00 201051000000101 636211000000110 Asthma trigger - animals Y
1788.00 201191000000108 305961000000113 Asthma trigger - cold air Y
1785.00 201201000000105 305981000000116 Asthma trigger - damp Y
1784.00 201211000000107 306001000000115 Asthma trigger - emotion Y
178B.00 340901000000107 1739141000000119 Asthma trigger - exercise Y
1781.00 340911000000109 1739151000000116 Asthma trigger - pollen Y
1789.00 201031000000108 305571000000112 Asthma trigger - respiratory infection Y
1787.00 201041000000104 305591000000111 Asthma trigger - seasonal Y
1782.00 340921000000103 1739161000000118 Asthma trigger - tobacco smoke Y
1783.00 340931000000101 1739171000000113 Asthma trigger - warm air Y
9OJ1.00 185728001 285727014 Attends asthma monitoring Y
66Y5.00 390872009 1484905010 Change in asthma management plan Y
H47y000 41553006 69311016 Detergent asthma Y
8H2P.00 183478001 3082895019 Emergency admission, asthma Y
663d.00 708358003 3033971010 Emergency asthma admission since last appointment Y
8791.00 182724005 282486014 Further asthma - drug prevent. Y
679J000 527191000000104 1176501000000114 Health education - asthma self management Y
679J100 527211000000100 1176541000000112 Health education - structured asthma discussion Y
679J200 527231000000108 1176581000000116 Health education - structured patient focused asthma discuss Y
663V100 370218001 1208969012 Mild asthma Y
38DV.00 763695004 3643315013 Mini asthma quality of life questionnaire Y
663V200 370219009 1208970013 Moderate asthma Y
66Yu.00 811151000000105 2116171000000118 Number days absent from school due to asthma in past 6 month Y
663y.00 366874008 490425015 Number of asthma exacerbations in past year Y
663V000 370220003 1208971012 Occasional asthma Y
173c.00 57607007 95786019 Occupational asthma Y
8CMA000 527171000000103 1176461000000114 Patient has a written asthma personal action plan Y
388t000 448003001 2900370011 Royal College Physician asthma assessment 3 question score Y
388t.00 302331000000106 536221000000110 Royal College of Physicians asthma assessment Y
H35y600 23315001 39131015 Sequoiosis (red-cedar asthma) Y
663V300 370221004 1208972017 Severe asthma Y
66YA.00 390878008 1484911013 Step down change in asthma management plan Y
66Y9.00 390877003 1484910014 Step up change in asthma management plan Y
9NNX.00 698509001 2974554010 Under care of asthma specialist nurse Y
H35y700 56968009 497732010 Wood asthma Y
173d.00 57607007 95786019 Work aggravated asthma Y
663h.00 312454005 456164012 Asthma - currently dormant Y
9OJ..11 713711000000105 1564951000000110 Asthma clinic administration Y
8793.00 182726007 282488010 Asthma control step 0 Y
8CE2.00 183099005 283029017 Asthma leaflet given Y
9OJ4.00 185731000 285730019 Asthma monitor 1st letter Y
9OJ5.00 185732007 285731015 Asthma monitor 2nd letter Y
9OJ6.00 185734008 285734011 Asthma monitor 3rd letter Y
9OJ3.00 185730004 285729012 Asthma monitor offer default Y
9OJ8.00 185736005 285736013 Asthma monitor phone invite Y
9OJ7.00 185735009 285735012 Asthma monitor verbal invite Y
9OJ..00 713701000000108 1564941000000112 Asthma monitoring admin. Y
9OJZ.00 713701000000108 1564941000000112 Asthma monitoring admin.NOS Y
9OJA.00 270442000 405055018 Asthma monitoring check done Y
66YE.00 390940007 1484970018 Asthma monitoring due Y
663O.00 170635006 264544010 Asthma not disturbing sleep Y
663Q.00 170638008 264547015 Asthma not limiting activities Y
9NI8.00 198971000000102 300371000000111 Asthma outreach clinic Y
663W.00 170647000 264556011 Asthma prophylactic medication used Y
13Y4.00 161105008 251191012 Asthma society member Y
178..00 400987003 1780194017 Asthma trigger Y
H330.12 233678006 350147016 Childhood asthma Y
9N4Q.00 89581000000109 138771000000113 DNA - Did not attend asthma clinic Y
9hA2.00 716491000000100 1569041000000114 Excepted from asthma quality indicators: Informed dissent Y
9hA1.00 717291000000103 1569831000000113 Excepted from asthma quality indicators: Patient unstable Y
9hA..00 715801000000103 1568361000000118 Exception reporting: asthma quality indicators Y
14B4.00 161527007 251716013 H/O: asthma Y
679J.00 401135008 1780336013 Health education - asthma Y
H332.00 195977004 301509017 Mixed asthma Y
9Q21.00 185940009 285891014 Patient in asthma study Y
8HTT.00 415265005 2533402016 Referral to asthma clinic Y
9OJ2.00 763221007 3638224019 Refuses asthma monitoring Y
9N1d.00 185242005 285239019 Seen in asthma clinic Y

Secondary Care

ICD-10 code ICD-10 term
J45 Asthma
J46 Status asthmaticus

Death

In the Office for National Statistics (ONS) mortality register, we used ICD-10 terms to identify where asthma was recorded as the underlying cause of death.

ICD-10 code ICD-10 term
J45 Asthma
J46 Status asthmaticus

Implementation

These codes will capture asthma ever, not just current asthma. These codes are not intended to be mandatory, but are to be used as a starting point for the identification of asthma in routine EHR. Each study may differ in the sensitivity and specificity of the coding required.

For those interested in further discrimination of asthma phenotypes, we refer you to Nissen et al. 2019.

F. Nissen, Douglas, I. J., Mullerova, H., Pearce, N., Bloom, C. I., Smeeth, L., and Quint, J. K., “Clinical profile of predefined asthma phenotypes in a large cohort of UK primary care patients (Clinical Practice Research Datalink)”, J Asthma Allergy, vol. 12, pp. 7-19, 2019.

Validations

Al Sallakh et al. and Nissen et al. both reviewed the literature for the validation of asthma in EHR in 2017. They found that high PPV were possible using a variaty of methods; however, there was high heterogeneity in the methods used.

  • F. Nissen, Quint, J. K., Wilkinson, S., Mullerova, H., Smeeth, L., Douglas, I. J., “Validation of Asthma Recording in Electronic Health Records: A Systematic Review”, Clinical Epidemiology, vol. 9, p. 643-656, 2017.

  • F. Nissen, Quint, J. K., Wilkinson, S., Mullerova, H., Smeeth, L., Douglas, I. J., “Validation of Asthma Recording in Electronic Health Records: Protocol for a Systematic Review “, BMJ Open, vol. 7, p. e014694, 2017.

  • M. A. Al Sallakh, Vadileiou E., Rodgers, S. E., Lyons, R. A., Sheikh, A., Davies, G. A., “Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review”, Eur Respir J, vol. 49, p. 1700204, 2017.

Publications

Publications from 2019 using validated Read codes from Nissen et al. 2017

  • F. Nissen, Douglas, I. J., Mullerova, H., Pearce, N., Bloom, C. I., Smeeth, L., and Quint, J. K., “Clinical profile of predefined asthma phenotypes in a large cohort of UK primary care patients (Clinical Practice Research Datalink)”, J Asthma Allergy, vol. 12, pp. 7-19, 2019.

  • C. I. Bloom, Walker, S., and Quint, J. K., “Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006-2017”, J Asthma, pp. 1-7, 2019.

  • D. Dedman, Coton, S. J., Ghosh, R. E., Meeraus, W., Crim, C., Harvey, C., Amelio, J., and Landis, S. H., “Treatment Patterns of New Users of Fluticasone Furoate/Vilanterol in Asthma and COPD in UK Primary Care: Retrospective Cohort Study”, Pulmonary Therapy, vol. 5, pp. 81-95, 2019.

Publications from 2019 using Read codes from QOF

  • P. Rockenschaub, Jhass, A., Freemantle, N., Aryee, A., Rafiq, M., Hayward, A., and Shallcross, L., “Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD)”, J Antimicrob Chemother, 2019.