Severe Asthma v1

Query purpose: 

This definition intends to capture emergency department visits for asthma with acute exacerbation, asthma attacks, bronchospasm, status asthmaticus, and severe asthma.

How it was developed: 

The CDC National Syndromic Surveillance Program (NSSP) team and SMEs from the CDC Asthma and Air Quality Branch worked with four jurisdictions (CO, KY, Polk Co. FL, NM) to pilot a v1 definition using ED data.

1. The NSSP team and asthma SMEs evaluated the chief complaint text and diagnostic codes in the CDC Asthma CCDD v1 definition and in a draft query developed in the advanced query tool (AQT) by the asthma SMEs, assessing which terms are necessary for identifying severe manifestations of asthma and what additional terms should be included.
2. The first iteration of the new definition (see Appendix) was created by the NSSP team and shared with asthma SMEs for their review.
3. Based on the comments and edits from CDC asthma SMEs, two additional iterations of the definition were made before a final draft of the definition was shared with jurisdictions for validation.

How it works:

The Chief Complaint Discharge Diagnosis (CCDD) parsed field is used to query both the discharge diagnosis codes and chief complaint free text, and exclusions are incorporated as necessary.

• Inclusion based on complaint free text terms related to severe forms of asthma emergencies:
  • The visit is included if it contains:
    1. A chief complaint related to asthma attack – (“asthma attack” or “asma attack” or “ashtma attack” or “asthama attack” or “asthmia attack”) OR
    2. A chief complaint for asthmaticus – (“asthmaticus”) OR
    3. A chief complaint for bronchospasm – (“bronchospasm”) OR
    4. A chief complaint related to severe asthma – (“severe asthma” or “severe asma” or “severe ashtma” or “severe asthama” or “severe asthmia”) OR
  • The visit is included if it contains the following set of terms nested together:
    1. A chief complaint term related to asthma – (“asthma” or “ asma” or “ashtma” or “asthama” or “asthmia”) AND
    2. A chief complaint term related to acute exacerbation – (“acute” or “exacerbation”) OR
• Inclusion based on ICD-10 discharge diagnosis codes related to bronchospasm, asthma with acute exacerbation, or asthma with status asthmaticus:
  • The visit is included if it contains:
    1. A discharge diagnosis code related to mild intermittent asthma – (J45.21 or J45.22) OR
    2. A discharge diagnosis code related to mild persistent asthma – (J45.31 or J45.32) OR
    3. A discharge diagnosis code related to moderate persistent asthma – (J45.41 or J45.42) OR
    4. A discharge diagnosis code related to severe persistent asthma – (J45.51 or J45.52) OR
    5. A discharge diagnosis code related to unspecified asthma – (J45.901 or J45.902) OR
    6. A discharge diagnosis code related to bronchospasm – (J45.990 or J98.01) OR
• Inclusion based on ICD-9 discharge diagnosis codes related to bronchospasm, asthma with acute exacerbation, or asthma with status asthmaticus:
  • The visit is included if it contains:
    1. A discharge diagnosis code related to extrinsic asthma – (493.01 or 493.02) OR
    2. A discharge diagnosis code related to intrinsic asthma – (493.11 or 493.12) OR
    3. A discharge diagnosis code related to chronic obstructive asthma – (493.21 or 493.22) OR
    4. A discharge diagnosis code related to unspecified type of asthma – (493.91 or 493.92) OR
• Inclusion based on SNOMED discharge diagnosis codes related to bronchospasm, asthma with acute exacerbation, or asthma with status asthmaticus:
  • The visit is included if it contains:
    1. A discharge diagnosis code related to exacerbation of asthma – (281239006 or 708090002) OR
    2. A discharge diagnosis code related to exacerbation of allergic asthma – (762521001 or 782513000 or 782520007 or 10674791000119101 or 707981009 or 10675911000119109 or 10676271000119104 or 10676431000119103 or 10675471000119109) OR
    3. A discharge diagnosis code related to exacerbation of intermittent asthma – (425969006) OR
    4. A discharge diagnosis code related to exacerbation of mild persistent asthma – (707445000 or 707981009) OR
    5. A discharge diagnosis code related to exacerbation of moderate persistent asthma – (707446004 or 734905008 or 707980005) OR
    6. A discharge diagnosis code related to exacerbation of severe persistent asthma – (707447008 or 707979007) OR
    7. A discharge diagnosis code related to exacerbation of immunoglobulin E-mediated allergic asthma – (708093000 or 708095007) OR
    8. A discharge diagnosis code related to life threatening acute exacerbation – (734904007) OR
    9. A discharge diagnosis code related to exacerbation caused by thunderstorms – (829976001) OR
    10. A discharge diagnosis code related to refractory exacerbation of asthma – (733858005) OR
    11. A discharge diagnosis code for acute exacerbation of chronic asthmatic bronchitis – (442025000) OR
    12. A discharge diagnosis code related to exacerbation of asthma co-occurrent with allergic rhinitis – (10674711000119105 or 10675991000119100 or 10676511000119109 or 10675551000119104) OR
    13. A discharge diagnosis code for chronic obstructive asthma co-occurrent with acute exacerbation of asthma – (10692721000119102)
• There are no exclusions in this query.

For consideration:

Although the syndrome definition has an emphasis on identifying visits for severe forms of asthma emergencies, other respiratory diseases and other conditions can be attributed to similar symptoms of wheezing, coughing, and chest pain so it may be difficult to determine whether an asthma emergency or another condition is the main reason for the visit.