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FeNO for Research

FeNO – The biomarker supporting research

The measurement of fractional exhaled nitric oxide (FeNO) has emerged as a valuable and non-invasive biomarker for assessing Type 2 airway inflammation.1,2 It has been used in pivotal clinical research studies for over a decade.3-6 In this article, find out how FeNO fulfils the criteria to be an ideal biomarker, and how it can help support your research.7

Last updated: November 2024

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FeNO’s role in determining inclusion criteria, monitoring treatment responses, and validating study outcomes makes it a valuable tool for clinical research in asthma diagnosis and management.2,8-10

FeNO is a useful and indicative biomarker of Type 2 airway inflammation, common in conditions such as asthma.2,11 FeNO testing has proven itself invaluable in phenotyping asthma and predicting responses to targeted therapies, as well as assisting in the development of enhanced treatment options such as biologics.10


The role of FeNO in clinical research

FeNO testing provides an objective measure of airway inflammation, offering real-time data due to immediate results that allow for quick diagnosis and treatment.2,12 Some of the key applications of FeNO in research include:

1. Inclusion and Exclusion Criteria

FeNO testing can be an effective tool when determining patient eligibility for clinical trials. It is non-invasive and the FeNO results are immediate, allowing for instant decisions about patient inclusion or exclusion based on their level of airway inflammation. 2,12

2. Monitoring Drug Responsiveness

FeNO can be used throughout a study to assess drug responsiveness, including for biologics.2,8-10 By measuring changes in airway inflammation, you can evaluate the effectiveness of treatments throughout the trial.2,8-10 FeNO helps provide a key opportunity for personalized medicine allowing researchers and healthcare professionals to tailor treatment protocols based on individual characteristics.13,14 Continued research and personalized approaches to treatments are essential for advancing asthma management and improving patient outcomes.10 For example, if FeNO levels remain elevated, it may suggest that a patient is not responding optimally to treatment, warranting therapeutic adjustments.8,9,14,15

3. Validating Study Results

FeNO's ability to provide reproducible and accurate results makes it an excellent marker for validating study outcomes.13,16,17 The accuracy and reproducibility of FeNO measurements could help support the reliability of a study’s findings which focus on Type 2 airway inflammation.16-18 

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Conclusion

FeNO is a reliable biomarker that can be used for clinical research, offering a non-invasive, objective measure of Type 2 airway inflammation.2,8,18 Its role in determining inclusion criteria, monitoring treatment responses, and validating study outcomes makes it a valuable tool for clinical research in asthma diagnosis and management.2,8-13 With the precision and portability of NIOX® devices, FeNO testing can be easily integrated into research protocols without the need for multiple measurements.16-20 NIOX® has been used in over 6,000 studies, being the device of choice for research.21

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References:

  1. 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. 
  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. 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. 
  4. American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med. 2005;171(8):912-30 
  5. Buchvald F et al. Measurements of exhaled nitric oxide in healthy subjects age 4 to 17 years. Journal of Allergy and Clinical Immunology. 2005;115(6):1130-6. 
  6. Kharitonov S et al. Reproducibility of exhaled nitric oxide measurements in healthy and asthmatic adults and children. European Respiratory Journal. 2003;21(3):433-8. 
  7. Zacharasiewicz A. Fractional exhaled nitric oxide and induced sputum. Paediatr Respir Rev. 2007;8(1):94-6. 
  8. Busse W et al. Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. The Lancet Respiratory Medicine. 2021;9(10):1165-73. 
  9. Heaney LG et al. Medical Research Council UK Refractory Asthma Stratification Programme (RASP-UK). Remotely monitored therapy and nitric oxide suppression identifies nonadherence in severe asthma. Am J Respir Crit Care Med. 2019;199(4):454-464. 
  10. Javid S et al. Recent Advances In Asthma Management And Treatment: A Comprehensive Review. IJRAR-International Journal of Research and Analytical Reviews (IJRAR). 2024;11(3):293-7. 
  11. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2024. Available at: https://ginasthma.org/2024-report
  12. Czubaj-Kowal M et al. Relationship between air pollution and the concentration of nitric oxide in the exhaled air (feno) in 8–9-year-old school children in Krakow. International Journal of Environmental Research and Public Health. 2021;18(13):6690. 
  13. Pianigiani T et al. Exploring the interaction between fractional exhaled nitric oxide and biologic treatment in severe asthma: A systematic review. Antioxidants. 2023;12(2):400. 
  14. Loewenthal L et al. FeNO in asthma. Semin Respir Crit Care Med. 2022;43:635-645 
  15. 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. 
  16. Carroll WD. NIOX VERO: Individualized Asthma Management in Clinical Practice. Pulmonary Therapy. 2016;2:171-88. 
  17. Gao J et al. Association between fractional exhaled nitric oxide, sputum induction and peripheral blood eosinophil in uncontrolled asthma. Allergy, Asthma & Clinical Immunology. 2018;1 
  18. 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. 
  19. 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. 
  20. Provenzano B et al. Use of fractional exhaled nitric oxide as a potential predictor of bronchodilator response. Medicine. 2023;102(28):e34073. 
  21. NIOX® Data on File; MKT-DOF-007. 2023. 


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