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FeNO Testing

Can FeNO help to reduce ICS dosage?

FeNO testing serves recognised benefits in respiratory care regarding airway inflammation in conditions such as asthma. FeNO is sensitive to inhaled corticosteroids (ICS), so in this article we will explore how FeNO testing supports asthma management and the potential for reduction of ICS dosage.

Last updated: March 2025

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FeNO can help to safely step-down ICS dosage, due to its ability to simply and quickly measure the level of inflammation present in the lungs

FeNO testing measures the level of inflammation in the airways though a simple breath test.2,3 This can be beneficial for both diagnosis and management of asthma, with recent guidelines released by NICE in the UK recommending that FeNO be tested to support a diagnosis alongside symptoms, and at every asthma review for on-going management.5

FeNO is exquisitely sensitive to ICS medications.1 This means that if a patient presents with a high FeNO, it is likely that ICS medications would lower their FeNO levels.1,2,6 This can help to improve patient outcomes and control of their condition.7 Due to being sensitive to ICS, FeNO can also help you to monitor adherence or notice if patients do not have correct inhaler technique.1,8 Alongside this, it can help to identify suitable candidates for biologics if FeNO remains high despite ICS treatment with full adherence.9

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Can FeNO help to reduce ICS dosage?

FeNO for ICS dosage

FeNO can be useful in dose titration of inhaled corticosteroids.10 But how do we know this? A study by Smith et al. showed that the optimal ICS dosage was up to 40% lower when guided by FeNO than with standard care.11 Another study by Hanania et al. showed that when using FeNO testing, around 30% of healthcare professionals changed their treatment decisions, further demonstrating the use of FeNO for optimising patient treatments.8 Inflammation cannot be guessed; FeNO offers a simple and objective way to measure it.3

FeNO can help to safely step-down ICS dosage, by simply and quickly measuring the level of inflammation present in the lungs, allowing for easy monitoring of a patient’s condition, and giving confidence to both patient and healthcare professional.2-4,8,12

The positive message behind this is that FeNO can help prevent patients from receiving ICS unnecessarily, or higher than necessary doses, whilst managing their condition and reducing the chance of exacerbations.2,9 For paediatric patients especially, avoiding long-term use of high dose ICS  could potentially reduce the associated long-term side effects.13

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Can FeNO help to reduce ICS dosage?

But why FeNO?

FeNO is the only available point-of-care, non-invasive measure of Type 2 airway inflammation.14 Whilst other tests include signs and symptoms or measuring airway obstruction, FeNO gives you a measurement for the inflammation in the airways, which is a key characteristic of asthma.8,15

FeNO takes just 10 seconds to test, meaning that it can be easily integrated into your asthma care. Additionally, the accuracy and repeatability of NIOX® technology means that only one test is required for a precise FeNO measurement.8,16,17 As the NIOX VERO® has an additional inhalation step, you can be assured that the measurement on the screen is the exhaled nitric oxide directly from the patients’ lungs, with no environmental NO contamination. Learn more about the technology behind NIOX® here.

To conclude, by using FeNO testing in your asthma care, you can safely optimise inhaled corticosteroid dosages and manage your patients effectively.2,9 Levels of inflammation in patients can vary, and therefore their treatment should too. Diagnose and manage confidently with FeNO testing.12,18

If you want to see FeNO testing for yourself, check out FeNO by NIOX® in action in our clinical videos for adults and paediatrics, or book a demo of NIOX VERO® to see it for yourself.

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References:

  1. Louis R et al. European Respiratory Society guidelines for the diagnosis of asthma in adults. European Respiratory Journal. 2022;60(3). 
  2. Ali H et al. The Potential of Fractional Exhaled Nitric Oxide as a Biomarker in Predicting and Optimizing Use of Treatment in Asthma. South East European Journal of Immunology. 2023;6(1):18-23. 
  3. Alving K et al. Validation of a new portable exhaled nitric oxide analyzer, NIOX VERO®: randomized studies in asthma. Pulm Ther. 2017;3:207-218. 
  4. Wang K et al. Using fractional exhaled nitric oxide to guide step-down treatment decisions in patients with asthma: a systematic review and individual patient data meta-analysis. Eur Respir J. 2020;55(5):1902150. 
  5. National Institute for Health and Care Excellence (NICE). NICE guideline. Asthma: diagnosis, monitoring and chronic asthma management. 2024. Available at; https://www.nice.org.uk/guidance/ng245 
  6. Dweik RA et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-15. 
  7. NHS England. Fractional Exhaled Nitric Oxide (FeNO). Available at; https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/rapid-uptake-products/fractional-exhaled-nitric-oxide/. 
  8. Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418. 
  9. Loewenthal L et al. FeNO in asthma. Semin Respir Crit Care Med. 2022;43:635-645 
  10. Porsbjerg C et al. Asthma. The Lancet. 2023. 
  11. Smith AD et al. Use of exhaled nitric oxide measurements to guide treatment in chronic asthma. N Engl J Med. 2005;352(21):2163-73. 
  12. Primary Care Respiratory Society (PCRS). At a glance – FeNO testing in asthma. Available at; https://www.pcrs-uk.org/sites/default/files/resource/2023-May-PCRU-FeNO-testing-asthma.pdf. 
  13. NHS England. Steroid inhalers. Available at: https://www.nhs.uk/conditions/steroid-inhalers/. Accessed: Feb 2025 
  14. Kuo C et al. Scottish consensus statement on the role of FeNO in adult asthma. Respiratory medicine. 2019;155:54-7. 
  15. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2024. Available at; https://ginasthma.org/2024-report/ 
  16. Provenzano B et al. Use of fractional exhaled nitric oxide as a potential predictor of bronchodilator response. Medicine. 2023;102(28):e34073. 
  17. Carroll WD. NIOX VERO: Individualized Asthma Management in Clinical Practice. Pulmonary Therapy. 2016;2:171-88. 
  18. Kaya T et al. The Fractional exhaled Nitric Oxide (FeNO)-test as add-on test in the diagnostic work-up of asthma: a study protocol. BMC Pulmonary Medicine. 2024;24(1):178. 


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