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Physician FeNO testing young male with parent

Asthma Guidelines and FeNO

Updated asthma guidelines reflect the increasing amount of literature evidence that describes the value of FeNO monitoring in asthma management.1


The joint guideline on the management of severe asthma published by the European Respiratory society (ERS) and the American Thoracic Society (ATS) in 2020 recognises the use of FeNO measurements to identify candidates for treatment with biologics.


In September 2011, the ATS published a clinical practice guideline on the interpretation of exhaled nitric oxide levels for clinical applications. This guideline was designed for clinicians and provided evidence-based recommendations for the use and interpretation of exhaled nitric oxide measurements in clinical practice.2

ACAAI & AAAAI Joint Statement of Support

In February 2012, the ATS guideline was formally endorsed and supported by the American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Allergy, Asthma and Immunology (AAAAI).3


In the US, the National Institute for Health (NIH) worked with the Agency for Healthcare Research and Quality (AHRQ) to publish in 2017 an extensive evidence-based review of FeNO which supports its use in the diagnosis and management of asthma.4


In 2018, the Global Initiative for Asthma (GINA) was also updated and now includes recommendations for FeNO use.5 FeNO is also included in the 2019 GINA guideline on severe asthma.6


In 2017, the National Institute for Health and Care Excellence (NICE) in the United Kingdom recommended FeNO to help diagnose and manage asthma in adults and children. As part of this NG80 guideline, NICE has created an implementation resource for Primary Care.7


References: 1. Holguin F et al. Management of severe asthma: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J. 2020;55(1):1900588.  2. 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.  3. Zitt M et al. AAAAI/ACAAI Joint Statement of Support of the ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide for Clinical Applications. 2012  4. Wang Z et al. The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017.  5. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2018 Update. 2018.  6. Global Initiative for Asthma (GINA). Difficult-to-treat and severe asthma in adolescent and adult patients, diagnosis and management. 2019.  7. National Institute for Health and Clinical Excellence (NICE). Asthma: diagnosis, monitoring and chronic asthma management. NICE guideline [NG80]. 2017.