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Asthma is defined as a chronic inflammatory disorder of the airways characterised by1
Acute asthmatic bronchiole
Many diseases present with symptoms similar to those seen in asthma.2,3 Understanding whether type 2 airway inflammation is present can help rule out these conditions and support a diagnosis of asthma.
Examples of conditions with symptoms similar to those seen in asthma:
During type 2 airway inflammation, higher-than-normal levels of nitric oxide (NO) are released from epithelial cells of the bronchial wall.4 The concentration of NO in exhaled breath, or fractional exhaled nitric oxide (FeNO), can help identify type 2 (eosinophilic driven) inflammation, and thereby support a diagnosis of asthma when there is diagnostic uncertainty.5
Normal epithelial cells typically release small amount of NO
During airway inflammation, activated epithelial cells increase production of NO
References: 1. National Asthma Education and Prevention Program; National Heart, Lung, and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma. Full report 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Published August 28, 2007. Accessed September 13, 2011. 2. Morice AH, Fontana GA, Sovijarvi ARA, et al; on behalf of the ERS Task Force. The diagnosis and management of chronic cough. Eur Respir J. 2004;24:481-492. 3. Tilles SA. Differential diagnosis of adult asthma. Med Clin N Am. 2006;90:61-76. 4. Van Den Toorn LM, Overbeek SE, De Jongste JC, Leman K, Hoogsteden HC, Prins J-B. Airway inflammation is present during clinical remission of atopic asthma. Am J Respir Crit Care Med. 2001;164:2107-2113. 5. Dweik RA, Boggs PB, Erzurum SC, et al; on behalf of the American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184:602-615.