How can FeNO support biologic therapy decisions?
Biologic therapies are becoming a pivotal treatment in moderate-to-severe asthma, being used when standard treatments alone don’t adequately manage symptoms.7
The decision to initiate biologic treatment depends on multiple factors, including exacerbation history, medication adherence, and levels of biomarkers such as FeNO and blood eosinophils.7,8 This is reaffirmed by the GINA guidelines, which highlight the complementary role of these biomarkers in guiding biologic add-on therapies.9
There are multiple approved biologics available, therefore, choosing the most suitable biologic can be complex. Measuring FeNO, alongside blood eosinophils and IgE, helps to identify the patient’s phenotype. Together, they provide information to help identify patients who are more likely to respond to a specific biologic and evaluate the effect of biologics, enabling a personalised approach to care.2 The approach of using biomarkers to identify responders can help to reduce reliance on potentially costly trial‑and‑error approaches and helps avoid prescribing biologics to patients who may not need them.10
For some biologics, such as dupilumab which targets the IL-4-IL-13 pathway, measuring FeNO and blood eosinophils is a requirement for prescription.2 For other biologics, studies have shown that higher baseline FeNO levels are generally associated with reduced exacerbation rates and improved asthma control, particularly in patients treated with omalizumab, dupilumab or tezepelumab.2
