Management Case Study - Addressing Poor Asthma Control Through FeNO Testing and Treatment Adherence

Patient profile

Gender/Age: Male in his 30s
History: Long-term asthma diagnosis, prescribed MART, using a combination inhaler twice daily with additional puffs as needed for symptom relief

Symptoms

Symptomatic most days
Night-time disturbances
Poor quality of life

Management Approach:

The patient was adamant about taking his medication as prescribed, but pharmacy records showed he had only used four combination inhalers in the past year (when 12 were expected). He also filled four prescriptions for short-acting bronchodilators (SABAs), which is unusual for someone on MART, as MART therapy should reduce the need for additional SABAs.

Asthma Control Test (ACT): Scored 14, indicating poor control

FeNO Test: 87 ppb, indicating significant uncontrolled inflammation despite reported use of combination therapy

The high FeNO level made it clear that the patient’s inflammation was not controlled, suggesting poor adherence to his inhaler therapy.

The patient was shown the results, and this helped him understand the need for better adherence to his prescribed treatment.

Outcome:

The patient was educated about the importance of consistently using MART therapy and the reasons for limiting the use of short-acting bronchodilators (SABAs).
His inhaler technique was also reviewed and corrected where needed.
After seeing his FeNO results, the patient acknowledged the need for better adherence and committed to improving his use of asthma medications.

Clinical Takeaway:

FeNO testing provided an important insight into the patient’s uncontrolled inflammation and poor adherence to therapy. Sharing the results with the patient helped motivate him to improve his asthma management. This case highlights the importance of combining FeNO testing with patient education to improve treatment adherence and prevent unnecessary medication escalation.