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How FeNO can improve asthma management and relieve the pressure on the healthcare system?

Acute asthma attacks often result in hospitalisation of both children and adults.1 It’s safe to say that acute asthma treatment requires significant healthcare resources.2 In this article we want to look at how regular use of FeNO measurement devices like NIOX VERO® can improve asthma management and could reduce the strain on the healthcare system.

FeNO (fractional exhaled nitric oxide) was discovered in the 1980s as a biomarker for airway inflammation. Over the past decades, authorities such as the European Respiratory Society and the American Thoracic Society (ATS) have created guidelines for optimal FeNO measurement.3,4 Today, FeNO testing is an important complement to traditional testing methods for better asthma control.

Measuring FeNO for better asthma diagnosis and treatment decisions

For many years, inhaled corticosteroids (ICS) have been a common treatment for asthma. However, research has shown that up to 45% of asthma patients don’t get any benefit from ICS therapy.4,5 As it can be difficult to diagnose asthma and assess steroid responsiveness, patients sometimes get unnecessary ICS treatment.6

FeNO measurement is a useful method for assessing type 2 airway inflammation that responds to ICS treatment.4,6 It is a quick and non-invasive test that can be done at the point of care. The NIOX VERO® has been proven to give accurate and reproduceable results and is recognised as a very reliable device.7,8

High levels of FeNO (> 50 parts per billion) mean a higher risk of potentially life-threatening asthma exacerbations.9 It can signal that the treatment with ICS should be increased or that patients are not taking their medicine consistently. Low FeNO values (< 25 parts per billion) could indicate good inflammation control, or even a lack of inflammation at all.4

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According to a study, doctors who did not test FeNO levels were unable to diagnose significant airway inflammation in 66% of the patients. Once high FeNO levels were identified, anti-inflammatory treatment was then stepped up in two thirds of patients.6

Other studies show that FeNO monitoring better predicts if patients will respond to ICS treatment compared to spirometry, bronchodilator response, peak flow variation, and bronchial hyper-responsiveness.10,11 Regular testing can also show if a patient is taking their medication as prescribed or if a patient is at risk of future exacerbations.12

Patient - Pre NIOX VERO Test - NIOX®

Patient - Pre NIOX VERO Test - NIOX®

Better asthma control, more healthcare resources

Asthma is a common illness, impacting 1 in 12 adults in the UK.1 It is the second most common reason for hospitalisation of children and the fourth most common reason of adults.13 It is estimated that about 20% of asthma patients have attacks that result in hospitalisation, but they account for about 80% of the total cost related to asthma.14

This is where FeNO monitoring can make a difference. One study concluded that the number of exacerbations went down by approximately 50%, when the treatment was based on a diagnosis that included FeNO monitoring.15

Another study looked at asthma in pregnancy.16 Here, FeNO measurements also proved to be beneficial for treatment decisions. There was a drop in exacerbations and the life quality of the patients improved, compared to the control group where FeNO monitoring was not included in the diagnosis. Babies born to mothers who were in the FeNO group were hospitalised less often.

Regular FeNO testing not only shows benefits in terms of asthma control, but the drop in acute attacks can also free up time and resources in hospitals. This was shown by a study in the US.17 Over a 12-month period, the costs per patient decreased significantly, from $2,637 to $2,228, when FeNO levels were included in the treatment decisions. The treatment was also more effective, as reflected in an increase in quality-adjusted life years from 0.767 to 0.844.

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1. Asthma UK. Last accessed 1st July 2020.
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8. Labeling Summary/Package Insert NIOX VERO® (EU). 000247-07, Nov 2017.
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