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Guidelines

Physician FeNO testing young male with parent - NIOX VERO®

FeNO Guidelines

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

ATS

In September 2011, the American Thoracic Society (ATS) published a clinical practice guideline on the Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications: an official ATS Clinical Practice Guideline. This practice 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

The ATS guideline was also formally endorsed and supported by the American College of Allergy, Asthma & Immunology (ACAAI) and the American Academy of Allergy, Asthma & Immunology (AAAAI).3

GINA

Recently, the Global Initiative for Asthma (GINA) was also updated and includes recommendations for FeNO use for patients with difficult-to-treat and severe asthma.4

AHRQ

In the US, the National Institute for Health (NIH) Agency for Healthcare Research and Quality (AHRQ) published an extensive evidence-based review of FeNO which supports its use in the diagnosis and management of asthma.5

NICE

FeNO has also been included in the most recent asthma guidelines in the United Kingdom; the National Institute for Health and Care Excellence (NICE) recommends FeNO to help diagnose and manage asthma in adults and children.6

NICE have also created an implementation resource for Primary Care.

EPR-4

Most recently, the Expert Panel Working Group, National Asthma Education and Prevention Program Draft has updated to include support for FeNO. 7

References

References: 1. Arnold RJ, Massanari M, Lee TA, Brooks E. A Review of the Utility and Cost Effectiveness of Monitoring Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management. Manag Care. 2018 Jul;27(7):34-41. 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 level (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184:602-615. 3. American Academy of Allergy, Asthma, and Immunology and American College of Allergy, Asthma, and Immunology. AAAAI/ACAAI joint statement of support of the ATS clinical practice guideline: interpretation of exhaled nitric oxide for clinical applications. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20 Documents/My%20Membership/FeNOJointStatement3-6-12.pdf. Accessed September 25, 2017. 4. Global Initiative for Asthma. Difficult-To-Treat & Severe Asthma in adolescent and adult patients: A GINA Pocket Guide For Health Professionals. https://ginasthma.org/wp-content/uploads/2018/11/GINA-SA-FINAL-wms.pdf. Accessed November 20, 2018. 5. Wang Z, Pianosi P, Keogh K, et al. The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management. Comparative Effectiveness Review No. 197 (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I). AHRQ Publication No.17(18)-EHC030-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2017. Available online at: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-197-fractional-exhaled-nitric-oxide_0.pdf (Accessed: August 30, 2019). 6. NICE guideline [NG80]: Asthma: diagnosis, monitoring and chronic asthma management. Published November 2017: https://www.nice.org.uk/guidance/ng80. Accessed August 20, 2019. 7. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program. Update on Selected Topics in Asthma Management: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. https://www.epr4workgroup.org/Asthma2020Guidelines/Shared%20Documents/Asthma-Guidelines-Report.pdf. Accessed February 18, 2020.