Codex Asthma: A practical tool for primary care providers to identify lung attack frequency and improve guideline adherence

Introduction: Lung attacks/exacerbations may occur across all asthma severities despite optimal medical therapy. Lung attacks are a significant burden for both patients and healthcare system. Prevention of attacks is one of the goals of asthma management. Patients with asthma in primary care with >1 attack per year should be referred to a specialist. However, in many cases attacks are neither documented nor coded in electronic medical records. For this study we developed a practical tool which provides more insight into lung attack frequency, which may facilitate asthma care and timely follow-up. CodeX tool: An algorithm to recognize lung attacks in Dutch patients with asthma (ICPC R96 and R96.2) aged ≥5 years was developed. We defined eight indicators to identify lung attacks, based on literature review and discussion with international scientific experts. The algorithm was evaluated in 5 general practices (n=1164 asthma patients). Results: In data from the past three years 1138 lung attacks were identified in 571 patients based on the algorithm; 167 (15%) of these attacks were coded with Dutch NHG-codes. 467 (40%) of all asthma patients were treated with an ICS, while 200 (35%) of the patients with a lung attack were not treated with an ICS nor started an ICS after the attack. 453 (39%) patients registered as having active asthma were not treated with inhalation therapy nor experienced an attack in the past 3 years. Patient characteristics are presented in table 1. Impact: We developed an algorithm and incorporated this in a practical tool for primary care providers to identify unrecorded lung attacks in their EMR and identify high risk and badly controlled patients. This could help primary care providers in identifying and closely managing high risk asthma patients by identifying lung attacks frequency and potential under- or overtreatment. Funding: This project is supported by AstraZeneca.