Month: January 2024

Electrochemical Sensor Technology: The new gold standard for FeNO testing

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A history of Fractional exhaled Nitric Oxide (FeNO) testing: where it all began

The story of FeNO began in the 1990s after it gained a lot of interest from researchers in the potential it posed as a non-invasive biomarker for airway inflammation. When airways are inflamed, Nitric Oxide (NO) is naturally produced by your body to help combat inflammation. This production of NO was observed by researchers to be significantly higher in patients with asthma. Researchers initially used a technology called ‘chemiluminescence’, to undertake research into FeNO and asthma. Over time, as FeNO testing evolved, so did available technologies on the market, and FeNO testing with electrochemical sensors was introduced as a more robust and cost-effective solution.

Chemiluminescence vs electrochemical FeNO technology: why electrochemical sensor technology is now considered ‘gold standard’

Both chemiluminescence and electrochemical sensor technology is adopted as a means of measuring and quantifying levels of nitric oxide in exhaled breath. Although both technologies are incredibly accurate and reliable when measuring exhaled nitric oxide, they both have note-worthy differences9. Whilst considered a highly sensitive and specific method for testing exhaled nitric oxide, chemiluminescence technology has some significant drawbacks, including the costly nature of the technology, and the additional complexity of using chemiluminescence devices9.

Chemiluminescence technology often requires additional specialist training as well as extra requirements for regular maintenance and calibration, which can lead to significant hikes in operational costs. Additionally, the size and portability of chemiluminescence devices are often at a disadvantage, as devices tend to be very bulky and less portable in comparison to other FeNO technologies such as electrochemical FeNO technology9.

Because of the difficulties chemiluminescence technology presented for widespread adoption in clinical practice, electrochemical technology was considered an alternative technology for carrying out FeNO testing in secondary and primary care. A number of studies were carried out comparing chemiluminescence technology to electrochemical technology, which found that there was a good correlation between the two technologies. A revolutionary finding, due to the cost-effective, accurate and portable nature of electrochemical technology for FeNO testing.

Electrochemical Technology and NObreath®: Dawn of A New Era

The need for more cost-effective, portable, and accurate solutions for FeNO testing was found in electrochemical technology, and a flurry of innovation from med-tech industries ensued, the NObreath® was born.

The NObreath® was developed by Bedfont® Scientific Ltd. in 2008, reflecting on over 10 years of FeNO development. Taking into consideration any obstacles current FeNO technology highlighted on market, the aim for Bedfont® was to develop the ultimate FeNO test solution, creating an electrochemical FeNO device developed with health care providers and patients in mind.

NObreath® vs alternative electrochemical FeNO technologies on the market: are they just as accurate?

NObreath® has been developed with accuracy and repeatability in mind and has been subject to the stringent processes of CE, FDA, CFDA and PMDA clearance (to name but a few) as part of their respective product registration and have also been shown in clinical research to result in excellent repeatability, reproducibility and comparability.

Additionally, the NObreath® device’s electrochemical sensor has been validated against chemiluminescence technology and has shown a good correlation between both technologies7. The NObreath® has been subject to many clinical studies and case study write-ups proving its accuracy and repeatability.

Further to clinical studies, case studies, and scrutiny by a number of different regulatory bodies, NObreath® has been subject to a number of lab condition tests to ensure accuracy, repeatability and stability of the electrochemical sensor, for up to 29,000 tests*, giving patients and healthcare professionals continued and accurate use with the NObreath®.

Finally, in addition to FeNO testing being a widely adopted test for airway inflammation in asthma patients such as ATS and ERS FeNO guidelines1, the NObreath® is one of three FeNO devices recommended by NICE5, an independent international organisation responsible for driving improvement and excellence in the health and social care system.

NObreath®: Breaking barriers in innovation and accessibility for all

NObreath® breaks barriers with its innovative features, making NObreath® the device of choice for healthcare providers.

Instant results

Why wait? Save precious clinic time with the NObreath® by receiving an instant and accurate FeNO test result.

‘No nonsense’ pricing for a cost-effective solution

NObreath® prides itself on being the most cost-effective FeNO solution on the market, by providing competitive pricing for mouthpieces and NObreath® devices. This is in addition to a long shelf life for mouthpieces, making test per patient the most cost-effective solution for operational overheads, increasing accessibility to all.

Incentive flow rate

The NObreath® has a selection of incentive flow rates suitable for all ages, to ensure patients exhale to a flow rate of 50ml/s for optimal and accurate FeNO testing.

FeNO testing without limits

The NObreath® has been designed to ensure continued use, meaning your device can be used over and over again**, reducing cost to your clinic, and limiting wastage for better environmental sustainability. Furthermore, to ensure continued use of your NObreath®, our easy ‘plug and play’ components mean healthcare professionals can easily maintain the NObreath® on-site without having to delay or suspend clinics due to off-site servicing or delay in having to purchase a new FeNO device.

Integrated infection control

The NObreath® device has integrated antimicrobial technology, in addition to integrated bacterial and viral filters in the NObreath® mouthpieces for improved infection control. Simple exhalation-only technique.

Simple exhalation-only technique

The exhalation-only technique on the NObreath® makes FeNO testing easy for all. There is no need to inhale through the device, as our partitioning method ensures any ambient NO is removed from the breath sample. As the breath sample enters the NObreath®, the first few seconds are partitioned and vented through the monitor bypassing the sensor chamber. After the partition period has elapsed, the pump will begin to draw the remaining viable sample into the sensor chamber, where the breath sample will be analysed in real-time. As the sensor measures the sample in real-time, by the end of the test, the result is instantly shown onscreen. Removal of potential environmental NO is advised by ‘ATS/ERS recommendations 2005 for standardized procedures for the measurement of exhaled nitric oxide (FeNO) testing’1, so you can have peace of mind that your FeNO result is accurate and dependable. Learn more about our partitioning method here: https://www.nobreathfeno.com/measuring-feno-with-the-nobreath/

Electrochemical technology: The new ‘gold standard’ for FeNO testing

The evidence showing the comparison to the NObreath® electrochemical FeNO device is directly comparable to chemiluminescence technology and other available electrochemical FeNO technology on the market; you can be sure that you own the ultimate FeNO test solution, an easy-to-use exhalation-only device, providing health care professionals with accurate and reliable results, utilising ‘gold standard’ and cost-effective electrochemical technology, with added portability for clinic use, and much more.

Visit https://www.nobreathfeno.com to find out how you can support your patients with FeNO monitoring, with the NObreath® from Bedfont® Scientific Ltd.


*Subject to correct use, maintenance and servicing
** Subject to 29,000 tests


References:
1. American Thoracic Society and European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine. 2005;171(8):912-930.

2. Inoue Y, Sato S, Manabe T, Makita E, Chiyotanda M, Takahashi K, Yamamoto H, Yanagida N, and Ebisawa M. Measurement of exhaled nitric oxide in children: A comparison between NObreath® and NIOX VERO® analyzers. Allergy, asthma and immunology research. 2018;10(5):478-489.

3. Harnan SE, Tappenden P, Essat M, Gomersall T, Minton J, Wong R, Pavord I, Everard M, and Lawson R. Measurement of exhaled nitric oxide concentration in asthma: A Systematic review and economic evaluation of NIOX MINO®, NIOX VERO®, and NObreath®. Health Technology Assessment. 2015;19(82):1-330.

4. Kang SY, Lee SM, and Lee SP. Measurement of fractional exhaled nitric oxide in adults: comparison of two different analysers (NIOX VERO® and NObreath®). Tuberculosis and Respiratory Diseases. 2021;84(3):182-187.

5. National Institute for Health and Care Excellence. Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO®, NIOX VERO®, and NObreath®[DG12]. 2014. Available from: https://www.nice.org.uk/guidance/dg12/chapter/5-Outcomes

6. Pisi R, Aiello M, Tzani P, Marangio E, Olivieri D, and Chetta A. Measurement of fractional exhaled nitric oxide by a new portable device: comparison with the standard technique. Journal of Asthma. 2010;47(7):805-809.

7. Antus B, Horvath I, and Barta I. Assessment of exhaled nitric oxide by a new hand-held device. Respiratory Medicine. 2010;104(9):1377-1380.

8. Yune S, Lee JY, Choi DC, and Lee BY. Fractional exhaled nitric oxide: Comparison between portable devices and correlation with sputum eosinophils. Allergy, Asthma and Immunology Research. 2015;7(4);404-408.

9. Maniscalco M;Vitale C;Vatrella A;Molino A;Bianco A;Mazzarella G; M. Fractional exhaled nitric oxide-measuring devices: Technology updateMauro [Internet]. U.S. National Library of Medicine; 2016 [cited 2023 Nov 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/27382340/

Dietary Challenges

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After the festive season, taking care of your gut health is vital. This time of year is one for feasting, socialising, and spending time with friends and family. However, it also means significant changes in regime and diet. For some, the festive season brings challenges in the form of dietary concerns and gastro symptoms. Thus, it is no surprise that studies show that about one-third of people experience digestive issues during this period.

Many people experience issues like abdominal pain, bloating, diarrhoea, and indigestion. There are multiple reasons for digestive problems during the festive season.

This time of year often results in overindulgence in food, significant dietary changes, consuming foods that a person does not regularly consume and mixing different foods.

This is not to suggest that one should not enjoy the time. However, if you are better prepared, you can likely manage most gastrointestinal issues using home remedies or over-the-counter medications. Moreover, taking timely action may help prevent more severe consequences and a visit to a doctor.

Hence, to manage gastro symptoms effectively, it is vital to understand its causes and what part of the gastrointestinal tract is affected. It could be the upper part, the middle part, or the lower part of the digestive system.

Issues of Upper Gastrointestinal Tract

One can consider the oesophagus (food pipe) and stomach as the upper parts of the gastrointestinal tract. Even though digestion begins in the mouth, most digestive processes start in the stomach, where several digestive enzymes and hydrochloric acid are secreted.

Overeating or eating certain kinds of foods, like those high in fats or consuming too much alcohol, may cause stomach pain, heartburn, and bloating.

One of the most common issues people experience during the festive season is Gastro-oesophageal reflux disease (GORD), which can result in upper gastric symptoms. Certain foods and alcohol may also damage the upper lining of the stomach.

GORD can cause burning chest pain (located in the middle of the chest and may radiate towards the back). Some may even confuse it with heart pain.

It mainly occurs due to the high production of acid in the stomach. Some of this acid makes its way to the lower part of the esophagus, causing pain or heartburn. Overeating or consuming certain foods may loosen the lower oesophageal sphincter (valve), which prevents the backflow of the stomach’s content towards the food pipe.

Most cases of GORD can be managed with great success. One can benefit significantly from over-the-counter medications such as antacids which neutralise the acid and provide almost immediate pain relief. Additionally, one may benefit from other natural remedies like chamomile, licorice and by drinking different teas. It’s important for individuals with GORD to practice moderation and choose lighter, less acidic options when possible.

Mid-Gastrointestinal Tract or Small Intestine Issues

Understanding that most digestive processes occur in a small intestine is vital. Absorption of most nutrients also happens in this part of the intestine.

If you experience bloating, gas, pain in the centre of the abdomen, discomfort, changes in appetite, or mild diarrhoea, then all these issues are likely to be associated with the small intestine. These problems may be due to malabsorption/food intolerance, local infection, or even due to local irritation.

The small intestinal issue often tends to be chronic and many people may benefit from commonly available remedies like digestive enzymes.

For individuals that have food allergies or intolerances, such as wheat, milk, fish, soy, sesame or nuts, this season can be particularly challenging, with hidden ingredients and cross-contamination becoming more prevalent in shared meals. Careful reading of labels and open communication with hosts can help those with food allergies enjoy their food safely.

For those with coeliac disease, there is a greater risk of gluten contamination during the holiday season with traditional foods like stuffing and sauces. Opting for gluten-free alternatives and educating loved ones about the importance of cross-contamination prevention.

One of the chronic issues affecting the small intestine is small intestine bacterial overgrowth or SIBO. This occurs due to an overgrowth of bacteria that are normally present in the small intestine. SIBO may be associated with irritable bowel syndrome, pancreatic issues, and intestinal motility issues. Studies suggest that a high prevalence of patients diagnosed with IBS have small intestinal bacterial overgrowth.

If someone continues to experience issues like frequent bloating and abdominal discomfort, it is advisable to consult with your doctor who may use some more specific tests to diagnose the condition. For example, a hydrogen methane breath test (HMBT) is an important diagnostic investigation for confirming SIBO, and to check if there is a malabsorption or food intolerance present. One such example is the ability of the HBMT to check for lactose malabsorption. This is one of the most common types of carbohydrate malabsorption in the world affecting more than half the world’s population. Symptoms may be mild or severe depending on the degree of lactase deficiency and the amount of lactose consumed.

Most of these intestinal issues are treated through dietary changes, certain medications, and using health supplements. Additionally, some may also benefit from a low FODMAP diet.

Lower-Gastrointestinal Tract or Large Intestine Issues

In this part of the intestine, absorption of water and some vitamins occurs. The final processing of foods happens in the large intestine before their elimination. The large intestine is also rich in microbiota, which has numerous roles in health.

Disturbances of the large intestine are most likely to cause chronic diarrhoea or even constipation. It may also cause pain if you are living with inflammatory bowel disease. One should keep in mind that dietary changes during the festive season may exacerbate inflammation.

There are a few ways to take care of your large intestine, like drinking ample water and being aware of your dietary fibre intake.

If you are living with inflammation, it is worth remembering that any dietary changes may cause worsening symptoms or flares. To prevent such issues, it is better to consult a doctor, as managing IBD is quite challenging.

The Bottom Line

Significant dietary changes and feasting during the festive season cause changes in gastrointestinal function in most individuals. Fortunately, most of these changes do not require medical attention and can be managed through home remedies or over-the-counter medications.

However, in some cases, issues like bloating, diarrhoea, abdominal pain, and discomfort become chronic. In such instances, it is a good idea to seek medical attention. Many of these issues occur due to food intolerance, IBS, SIBO, and other similar conditions. In many instances, hydrogen-methane breath testing is of significant help. Hydrogen and methane breath testing is also a valuable diagnostic tool that can support the management of gastrointestinal symptoms and dietary challenges during this period, allowing for better symptom control and informed decision-making.

Before attending a gathering, communicate with your host about your dietary restrictions, concerns, and allergies. This can help them to provide alternatives and prevent cross-contamination. Stay hydrated by drinking water throughout the day as hydration is crucial for good digestion and can help prevent constipation. Being mindful of portion sizes can help to prevent overindulging. Remember that enjoying your favourite treats is okay, but moderation is key.

By understanding the impact of seasonal foods on various gastrointestinal symptoms and conditions, people can make informed choices, communicate their dietary needs, and enjoy the festive season to the fullest.