FeNO Testing in Asthma Care
Although airway eosinophilic inflammation is a key characteristic of asthma, there are few methods available to measure it. This inflammation can be assessed by measuring eosinophils and eosinophilic cationic protein (ECP) in sputum or by measuring ECP in blood samples1. However, these methods are considered time-consuming, expensive, and not readily available.
For most asthma patients, airway inflammation is driven by an allergen-induced Th2 response2. Evidence from the literature suggests that fractional exhaled nitric oxide (FeNO) is a crucial biomarker for respiratory tract inflammation2. Elevated FeNO levels in asthma are thought to result from inducible NOS2 expression in the inflamed airways2. The NObreath® FeNO device provides a non-invasive and significantly more cost-effective alternative aid to diagnose asthma and assess airway eosinophilic inflammation.
This article delves into the challenges encountered within primary care and how the innovative technology of the NObreath® can assist. Additionally, the article discusses the transition of the use of the NObreath® from primary care environments to secondary care facilities.
Challenges in Primary Care
GPs often face restricted budgets due to resource allocation for population needs, and financial sustainability to stay within healthcare budgets and prevent overspending. Each patient appointment is typically limited to just 10 minutes.
Population needs
In the UK, approximately 5.4 million people, or about 8 in every 100 individuals, suffer from asthma3. The National Review of Asthma Deaths (NRAD) documented 195 asthma-related deaths among adults in 2013, highlighting preventable factors in 89 of the 195 deaths (46%), such as lack of specific asthma expertise (17%) and non-adherence to UK asthma guidelines (25%)4. FeNO testing is valuable in GP settings, as GPs often encounter a spectrum of asthma cases, from mild to severe. The NObreath® device facilitates rapid and reliable FeNO measurements, to allow GPs to make informed decisions and aid in identifying patients who do or do not require ongoing treatment5. This also reduces emergency visits and hospital admissions related to poorly controlled asthma.
Financial sustainability
One of the ongoing challenges in primary care is maintaining financial sustainability. The NObreath® FeNO device is cost-effective, with minimal ongoing costs. The device requires only one consumable- the NObreath® mouthpiece which has a long shelf life and an integrated infection control filter, effectively removes airborne bacteria (>99%) and viruses (>98%)6. The device also incurs low annual servicing costs and imposes no test limits*.
Time with patient
When a GP determines the need for a FeNO test using the NObreath®, there’s no warm-up time, and the device operates through a simple exhale-only technique with on-screen visual guidance. Patients receive instant results, eliminating wait times. Intended for adult and paediatric patients**, the NObreath® offers two test modes: a 10-second test mode for those up to 10 years old who cannot complete the 12-second test mode. GPs can store up to 25 results in up to 50 patient profiles and view a graph of results. If a GP office possesses only one NObreath®, they benefit from the device size and portability, ensuring that healthcare providers can efficiently utilise the device wherever patient care demands.
Carol Stonham, a member of Bedfont® Scientific Limited Medical Advisory Board and policy lead for Policy Care Respiratory Society (PCRS), comments “The NObreath® is my preferred choice for primary care in managing asthma for many reasons. Primarily it suits the unpredictability of the volume of testing in primary care – none of the consumables or device needs to be used or lost in a short time frame. It is an intuitive machine which is easy to use and teaches patients of all ages.”
Primary Care to Secondary Care
Using the NObreath® device in primary care can reduce the number of inappropriate referrals to secondary care clinics. However, if a patient is referred to an asthma specialist in secondary care, the NObreath® FeNO device can aid in the diagnosis and management of asthma. The NObreath® helps differentiate between allergic (eosinophilic) and non-allergic asthma7. FeNO measurements show the patient’s response to the treatment, enabling accurate prescription of medication and safer, monitored adjustments. This helps patients understand their condition better by demonstrating how their FeNO levels correlate with their symptoms and treatment adherence. Measuring airway inflammation with the NObreath® can help monitor the effectiveness of medication and predict the risk of asthma attacks8***
Gold Standard FeNO Testing
FeNO testing is increasingly recognised as a valuable tool in the management of asthma, but what makes the NObreath® stand out from other FeNO devices on the market? Developed by Bedfont® in 2008, the NObreath® has over 15 years of clinical use and has been featured in numerous studies worldwide, contributing to the advancement of FeNO testing. Conforming to both the American Thoracic Society (ATS) and European Respiratory Society (ERS) guidelines, the NObreath® is also one of three FeNO devices recommended by the National Institute for Health Care Excellence (NICE)9, an independent international organisation providing national guidance and advice to improve health and social care.
To find out how you can support your patients with FeNO testing in asthma care with the NObreath®, please visit: https://www.nobreathfeno.com/
*The NObreath® has been validated for up to 29,000 tests when used as instructed and properly maintained and serviced. The number of tests can be periodically checked within the settings of the device; when 29,000 tests are reached a service is recommended. Contact your local service centre.
**NObreath® can be used on paediatric and adult patients, provided they can follow test protocol. USA only: NObreath® can be used on patients 7+ years old.
***FeNO is not a definitive indication of asthma and should be used in conjunction with (but not limited to) spirometry, patient history, and symptoms.
References:
- Pizzichini E, Pizzichini MM, Efthimiadis A, Dolovich J, Hargreave FE. Measuring airway inflammation in asthma: eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. Journal of allergy and clinical immunology. 1997 Apr 1;99(4):539-44. DOI: 10.1016/S0091-6749(97)70082-4.
- Keller AC, Rodriguez D, Russo M. Nitric oxide paradox in asthma. Memórias do Instituto Oswaldo Cruz. 2005;100:19-23. PMID: 15962094 DOI: 10.1590/s0074-02762005000900005.
- What is Asthma? [Internet]. Asthma+ Lung UK. 2024. [Cited Monday 8th July 2024]. Available from: https://www.asthmaandlung.org.uk/conditions/asthma/what-asthma#:~:text=Asthma%20is%20a%20common%20condition,cough%20or%20a%20tight%20chest.
- Royal College of Physicians. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Report. London, RCP; 2014.
- Taylor DR, Pijnenburg MW, Smith AD, Jongste J. Exhaled nitric oxide measurements: clinical application and interpretation. Thorax. 2006 Sep 1;61(9):817-27. PMID: 16936238 PMCID: PMC2117092 DOI: 10.1136/thx.2005.056093.
- Public Health England. An Evaluation of Filtration Efficiencies Against Bacterial and Viral Aerosol Challenges. Salisbury: Public Health England; 2020.
- Ref: Coumou H, Bel EH. Improving the diagnosis of eosinophilic asthma. Expert review of respiratory medicine. 2016 Oct 2;10(10):1093-103. DOI: 10.1080/17476348.2017.1236688.
- Saito J, Gibeon D, Macedo P, Menzies-Gow A, Bhavsar PK, Chung KF. Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control. European Respiratory Journal. 2014 Feb 1;43(2):474-84. DOI: 10.1183/09031936.00048513.
- Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and NObreath [Internet]. National Institute for Health and Care Excellence. 2014. [Cited Wednesday 10th July 2024]. Available from: https://www.nice.org.uk/guidance/dg12/chapter/5-Outcomes