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“You can’t cheat FeNO!” - an interview with Dr Priya Ilangovan

A picture of Dr Priya Ilangovan

“I check inhaler technique and also use FeNO to assess compliance. Patients tell you “of course I’m taking my medication!” but they’re not. The FeNO number is there – and you can’t cheat FeNO!”

We were fortunate to catch up with consultant paediatrician Dr Priya Ilangovan to ask about her experience of testing fractional exhaled nitric oxide (FeNO) in children.1 Dr Ilangovan has been a paediatric consultant for 27 years, setting up the respiratory service in Basingstoke and North Hampshire Hospitals’ secondary care in the UK, as well as a dedicated asthma clinic. Here, Dr Ilangovan shares her experience of FeNO, as well as some thought-provoking asthma case-studies.1

How do you use FeNO testing for asthma diagnosis?

“FeNO is part of the diagnostic jigsaw,” Dr Ilangovan explains. “We take symptoms and a full clinical history, carry out an examination, review x-rays, test FeNO and perform spirometry for those who are able to.” For Dr Ilangovan, it all comes back to the right diagnosis. “Get the diagnosis right and then you can decide the treatment. Don’t send everybody home on inhaled steroids just because they come in with a wheezy episode. I undo the diagnosis of asthma in a third of the children who come to the four-week discharge clinic. FeNO can help tell you whether asthma is there or not.”1

FeNO is particularly helpful for patients requiring a straightforward test. “For instance, I tried spirometry on a four-year-old,” Dr Ilangovan says. “From the evidence, I was absolutely convinced he had asthma but he couldn’t manage spirometry. I asked him to take a FeNO test. Up came the number and my diagnosis was confirmed: he had Type 2 asthma. FeNO is really helpful in the pre-school age when they can’t manage the lung function tests.”1

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References

1. Interview with Dr Priya Ilangovan – NIOX®: https://www.niox.com/en/newsletter/april-2022/