The most recognised national and international scientific societies have produced recommendations for FeNO testing to help with more accurate diagnoses and better asthma management:
2023: European Respiratory Society1
- For diagnosis & management: FeNO is an important component for diagnosing, managing, and phenotyping asthma. FeNO is strongly suggested as an indispensable diagnostic tool in specialist pulmonology care.
2023: Global Initiative for Asthma2
- For therapy: FeNO is recommended for assessing the severe asthma phenotype during high-dose ICS treatment. FeNO is recognised as a strong predictor of a good response to certain biological agents.
2022: European Respiratory Society3
- For diagnosis: FeNO is recommended as part of the diagnostic process for adults with suspected asthma. The task force states a cut-off value of 40 ppb offers the best compromise between sensitivity and specificity, while a cut-off of 50 ppb has a high specificity close to 90% and is supportive of a diagnosis of asthma.
2021: American Thoracic Society4
- For therapy: FeNO measurements are recommended in addition to usual care to support the treatment of asthma patients.
2021: European Respiratory Society5
- For diagnosis: FeNO is strongly recommended as one of the initial tests for diagnosing asthma in children.
2021: National Institute for Health and Care Excellence (UK)6
- For diagnosis: Adults should be offered FeNO measurement if asthma is suspected. FeNO measurements should be considered in children (5-17 years) if there is diagnostic uncertainty after the initial assessment.
- For therapy: FeNO measurements should be considered as an option for the treatment of patients who are symptomatic despite inhaled corticosteroids (ICS).
2020: European Respiratory Society and American Thoracic Society7
- For therapy: FeNO is recommended for identifying suitable patients for some biologics.
2020: National Heart, Lung, and Blood Institute (USA)8
- For diagnosis: FeNO measurements may be used to help identify if a patient has asthma, and should be taken into account alongside other clinical factors.
- For therapy: FeNO measurements can be used for ongoing monitoring and management strategies to predict exacerbations and exacerbation severity. FeNO may also help direct stepwise therapeutic choices.
2011: American Thoracic Society9
- Published the widely used breakpoints for interpreting FeNO levels in adults and children (up to 12 years of age).
- For diagnosis: FeNO is strongly recommended for the diagnosis of type 2 airway inflammation in children and adults. FeNO is also suggested for the diagnosis of asthma when objective evidence is required.
- For treatment: FeNO is strongly recommended in patients with suspected airway inflammation to predict the likelihood of response to steroids.
- For therapy: FeNO is strongly recommended for monitoring airway inflammation in asthma patients. FeNO is also strongly recommended to predict response to ICS.
The importance of guidelines
Many national societies have produced asthma guidelines and strategies recognising the role of FeNO testing for:
- diagnosing airway inflammation and asthma
- enhancing asthma management through therapy and adherence optimisation, leading to a reduction of exacerbations
- choosing the right biologic in severe asthma
Countries with national guidelines include: USA, Japan, Italy, China, France, Mexico, Scotland, Spain, Malaysia, Australia...12-22
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