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Fractional exhaled nitric oxide (FeNO) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airway disease in asthma patients.
Specifically, FeNO is an objective measurement of T2 or allergic/eosinophilic inflammation. Airway inflammation results from the activation of mast cells and antigen-specific T-helper cells type 2 (T2) resulting in the production of cytokines including interleukin (IL)-4, IL-5, and IL-13.3 This is an important distinction as T2 allergic inflammation and eosinophilic inflammation are not one in the same. However, they are very closely associated with similar molecular pathways and crossover.
References: 1. Alving K, Malinovschi A. Basic aspects of exhaled nitric oxide. Eur Respir Mon. 2010;49:1-31. 2. Dweik RA, Boggs PB, Erzurum SC, et al; on behalf of the American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. 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):602-615. 3. Mahr TA, Malka J, Spahn JD, et al; Inflammometry in pediatric asthma: A review of fractional exhaled nitric oxide in clinical practice. Allergy Asthma Proc. 2013;34:210-219. 4. Circassia White Paper: Summary of Evidence Supporting the Clinical Value of Monitoring Exhaled Nitric Oxide (FeNO) in the Management of Asthma. Circassia Pharmaceuticals, Inc. May 2018. PP-VERO-US-0037 v2.0 5. Syk J, Malinovschi A, Johansson G, et al. Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial. J Allergy Clin Immunol Pract. 2013;1(6):639-648. 6. Peirsman EJ, Carvelli TJ, Hage PY, et al. Exhaled nitric oxide in childhood allergic asthma management: a randomised controlled trial. Pediatr Pulmonol. 2014;49(7):624-631.