FeNO Testing for UK Primary Care - GP Resource Centre

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FeNO and improving asthma outcomes

NICE Guidance

FeNO in Clinical Practice

   Why incorporate FeNO into routine clinical practice? 
 Mike Thomas, Professor of Primary Care Research 
     
   Managing asthma in children using FeNO: Two case  studies. 
 Will Carroll. Honorary Associate Professor. Consultant  Pediatrician
     
   How can we take away the guesswork for treatment  of complex asthma and chronic cough? 
 D. Robin Taylor, Professor of Respiratory Medicine
     
   Are inhaled steroids always the right treatment in asthma  and asthma- COPD overlap syndrome? 
 D. Robin Taylor, Professor of Respiratory Medicine

 

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Abbreviations

  • FeNO - Fractional Exhaled Nitric Oxide
  • ICS - Inhaled Corticosteroids
  • COPD - Chronic Obstructive Pulmonary Disease
  • CCG - Clinical Commissioning Group

Important Information Regarding NIOX®  

NIOX VERO® is a portable system for the non-invasive quantitative simple and safe measurement ofNitric Oxide (NO) in human breath (FeNO) and Nasal Nitric Oxide (nNO) in the aspirated air from thenasal cavity. For FeNO: Nitric Oxide is frequently increased in some inflammatory processes such asasthma and decreases in response to anti-inflammatory treatment. FeNO measurements should be usedas part of a regular assessment and monitoring of patients with these conditions. NIOX VERO FeNO issuitable for patients age 4 and above. As measurement requires patient cooperation, some childrenbelow the age of 7 may require additional coaching and encouragement. NIOX VERO FeNO can beoperated with 2 different exhalation times, 10 seconds and 6 seconds. The 10 second mode is thepreferred mode. For children who are not able to perform the 10 second test, the 6 second is analternative. The 6 second test should be used in caution with patients over the age of 10. It should notbe used in adult patients. Incorrect use of the 6 second exhalation test may result in falsely low FeNOvalues, which can lead to incorrect clinical decisions. For nNO: nNO has been shown to decrease inpatients with Primary Ciliary Dyskinesia (PCD) and measurement of nNO can assist in the identificationof cases of PCD. Measurement of nNO is suitable for patients age 5 and above. Suspected cases of PCDfollowing screening with nNO should be confirmed according to published recommendations for PCDdiagnosis and management.

References1. Smith AD, Cowan JO, Brassett KP, et al. Exhaled nitric oxide. A predictor of steroid response. Am J Respir Crit Care Med 2005; 172:453-9. 2. Powell H, Murphy VE, Taylor DR, et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide:a double-blind, randomised controlled trial. Lancet. 2011;378(9795):983-990. 3. Peirsman E, Carvelli T, Hage P, Hanssens L, Pattyn L, RaesM, Sauer K, Vermeulen F, Desager K. Exhaled Nitric Oxide in childhood allergic asthma management a randomised controlled trial. PediatricPulmonology, 2013. 4. Syk J, Malinovschi A, Johansson G, Undén A, Andreasson A, Lekander M, Alving K. Anti-inflammatory Treatment ofAtopic Asthma Guided by Exhaled Nitric Oxide: A Randomized, Controlled Trial. J Allergy Clin Immunol 2013. 5. Beck-Ripp J, GrieseM, Arenz S, Köring C, Pasqualoni B, Bufler P. Changes of exhaled nitric oxide during steroid treatment of childhood asthma. Eur Respir J.2002;19(6):1015-1019. 


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