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How FeNO-driven asthma management can save healthcare resources

Since its discovery in the 1990s, FeNO (fractional exhaled nitric oxide) has proved to be a helpful biomarker to guide asthma diagnosis and treatment decisions. In this article, we will show how FeNO testing can save the healthcare system money and make medical resources go further.

Asthma is a common illness that affects about 4.3 million people across the globe.1 Common asthma symptoms include cough, wheezing, breathlessness and chest tightness, which may be caused by airway inflammation.2

In the past few decades, research has confirmed the important role of inflammation in asthma.3 Inhaled corticosteroids (ICS) are anti-inflammatory medications and many studies have been carried out to optimise their use in asthma management.4 However, not all asthma patients can be treated effectively with ICS.5,6

What are the consequences of unnecessary ICS treatment for asthma?

Nurse FeNO testing female patient with NIOX VERO

A patient performing a FeNO test with NIOX VERO®

Research has shown that up to 45% of asthma patients don’t benefit from ICS.6 However, it can be difficult to diagnose asthma and assess steroid responsiveness, meaning patients sometimes receive unnecessary ICS.7

Long-term use of ICS can cause health issues such as cataracts, impaired growth in children, decreased bone mineral density, and skin thinning and bruising.7,8,9 Correct asthma diagnosis and treatment plans can therefore avoid unnecessary health problems and save healthcare resources.

How a FeNO-driven diagnosis can reduce costs for the healthcare system

A FeNO test is a quick, non-invasive procedure that can be performed at the point-of-care. FeNO has proved to be a good indicator for Type 2 airway inflammation and to detect patient responsiveness to ICS.5,7

Two studies led by Smith point out that FeNO monitoring better predicts whether patients will respond to ICS treatment compared to spirometry, bronchodilator response, peak flow variation, and bronchial hyper-responsiveness.10,11

To understand the financial impact of FeNO testing, NIOX® has developed a mathematical simulation model that shows potential savings when FeNO testing is part of the diagnostic process. It calculates the cost difference both for one year, as well as the accumulated costs over five years.

The model is based on the fact that around 30% of all asthma patients are misdiagnosed.12 Other variables taken into account are the cost of nurse time and unnecessary ICS prescriptions, as well as the additional cost of performing a FeNO test and potential follow-up assessments.

How much money could be saved in the UK by consistently testing FeNO?

To give you an idea of what this saving looks like in practice, we made a simulation for the UK (assuming a population of 67 million people). Every year, an average of 166,300 people over the age of five are diagnosed with asthma and will be prescribed ICS treatment. If we assume they were diagnosed without FeNO testing, the model predicts that 59,320 of these diagnoses are either wrong or identify an asthma type that doesn’t respond to ICS treatment.

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Introducing FeNO testing would save the healthcare system £2,924,606 in the first year. Since the amount accumulates over time, the model further predicts that FeNO testing caould save up to £23,265,332 over a period of five years, compared todiagnosing and managing asthma without it.

Considering the high number of misdiagnoses and the savings predicted by the model, it is safe to say that FeNO testing can have a substantial impact on asthma diagnostics and treatment, and on the efficient use of healthcare resources.

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References

1. Global Asthma Network. The Global Asthma Report. 2018.
2. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, 2018 Update. 2018..
3. National Heart, Lung, and Blood Institute. National asthma education and prevention program expert report 3: guidelines for the diagnosis and management of asthma. 2007.
4. Crompton G. A brief history of inhaled asthma therapy over the last fifty years. Prim Care Respir J. 2006;15(6): 326-31.
5. Dweik RA et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011 184(5):602-15.
6. Schleich F, Brusselle G, Louis R, et al. Heterogeneity of phenotypes in severe asthmatics. The Belgian Severe Asthma Registry (BSAR). Respir Med. 2014;108(12): 1723-1732.
7. Hanania N, Massanari M, Jain N. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018; 120: 414-418.
8. Syk, Jörgen MDa,b, et al. Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial. J Allergy Clin Immunol Pract. 2013; 1(6): 639-646.
9. Dahl R. Systemic side effects of inhaled corticosteroids in patients with asthma. Respir Med. 2006;100(8):1307-17.
10. Smith AD, Cowen JO, Brassett KP, et al. Exhaled nitric oxide: a predictor of steroid response. Am J Respir Crit Care Med. 2005;172: 453-459.
11. Smith AD, Cowan JO, Filsell S, et al. Diagnosing asthma: comparisons between exhaled nitric oxide measurements and conventional tests. Am J Respir Crit Care Med. 2004;169: 473-478.
12. Looijmang-van den Akker I et al. Overdiagnosis of asthma in children in primary care: a retrospective analysis. Br J Gen Pract. 2016;66(644): e152-e157.
13. Budget Impact Model UK. 2019. Data on file. Circassia Ltd.