Category: NObreath

Love Your Lungs Week is a national awareness event which occurs annually in June, taking place from 21st June to 27th June 2024. Initiated by the British Lung Foundation, now known as Asthma and Lung UK, the event focuses on enhancing lung health and looks to raise awareness of a variety of respiratory conditions that affect lung health. One of these conditions is asthma, which is a chronic condition where the airways become inflamed and narrowed, making breathing difficult.

What causes asthma?

It is thought that asthma is caused by a combination of genetic and environmental factors; when exposed to various irritants and substances, it can trigger asthma symptoms. There are 2 types of asthma; allergy-induced asthma and non-allergy induced asthma. Both types can have different triggers and these can vary from person to person.

Allergy-induced asthma is the most common form and can be triggered by inhaling allergens. This
can lead to an immune response in the airways which causes the symptoms of asthma. Common
allergens include:

• Pollen: From trees, grass and weeds.
• Dust Mites: Tiny creatures that thrive in household dust.
• Pet Fur: Shed by cats, dogs and other furry pets.
• Mould: Fungai that can grow indoors or outdoors in moist environments.

These can include:

• Respiratory Infections: Such as the common cold or influenza.
• Exercise: Especially in cold or dry air.
• Stress and Emotions: Intense emotions can lead to hyperventilation and tightness in the chest.
• Airborne Irritants: Such as smoke, chemical fumes, strong odours, or pollutants.

These triggers can cause the airways to swell and narrow but do not involve an allergic response. Instead, they may involve different inflammatory responses or hypersensitivity of the airways.

What impact does asthma have?

Asthma can have a significant impact on people’s lives, affecting their physical health, mental well- being and quality of life. The condition imposes lifestyle limitations, with sufferers often avoiding activities that might trigger symptoms, along with the economic burden from continuous medical care and loss of productivity due to absences from work or school.

Unfortunately, asthma-related emergency admissions remain high at over 35,000 in both adults and
children in the UK¹, and with 1,261 people sadly passing away in 2020¹, it is clear more needs to be
done to avoid these numbers increasing.

How does FeNO fit into asthma management?

• Diagnosis: FeNO testing can help in diagnosing asthma in cases where typical diagnostic tests (like spirometry) might not be conclusive. Elevated FeNO levels can suggest eosinophilic inflammation, which is a common underlying cause in many asthma patients.
• Monitoring: For ongoing asthma management, FeNO levels can provide insight into how well inflammation is being controlled through medication, particularly inhaled corticosteroids.
• Monitoring FeNO can help in adjusting medications more precisely to reduce inflammation.
• Predicting Exacerbations: High FeNO levels can indicate poorly controlled asthma and predict potential exacerbations. This can be particularly useful in managing patients who have periodic flare-ups, allowing for preventive adjustments in treatment.
• Assessing Treatment Response: Regular FeNO testing can assess the effectiveness of current asthma treatment regimens. If FeNO levels remain high despite treatment, it might suggest the need for alternative therapies or more aggressive management.

With World Asthma Day just a little over a month ago now, this years theme “Asthma Education Empowers” aimed to highlight the importance of education in asthma diagnosis and treatment. It is clear that the innovative approaches to its management, including FeNO testing, have never been more essential.

Bedfont® Scientific Limited, are world leaders in breath analysis, with over 47 years of expertise and knowledge in designing and manufacturing breath analysis devices. They are committed to improving patient safety through innovating breath analysis devices, such as the NObreath®. The device is a portable handheld FeNO device, used by healthcare professionals to aid in the diagnosis and treatment of asthma.

1. Public health profiles. Office for Health Improvement & Disparities. [cited on 7/5/24] Available from
https://fingertips.phe.org.uk/search/asthma

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/

As we enter the winter months and it becomes cold outside, the air we breathe is dry and the protected fluid in our lungs evaporates. This environmental change triggers the muscles within our lungs to spasm as they work to maintain open airways, resulting in increased tightness and difficulty breathing. While asthma symptoms persist throughout the year, they can escalate during winter, aggravating issues such as chest pain, coughing, shortness of breath, chest tightness, and wheezing¹.

Asthma is recognised in part by the variability of symptoms. Indeed, this variability is a key consideration in making the diagnosis of asthma². Once a diagnosis is confirmed, asthma symptoms can continue to demonstrate variability. This variability may be unpredictable and unexpected due to the natural disease process, or more predictable because of exposure to individual triggers.

Asthma guidelines state that if symptoms worsen, the clinician should check adherence with prescribed medication, check inhaler technique and remove triggers². This may be overlooked when increasing doses of inhaled medication or prescribing additional medications. It is worth thinking about how this can be done in practice.

Medication adherence can be a tricky subject to bring into the consultation. It is a complex mix of patients’ health beliefs or misjudgement of their condition^3,4 and can also be influenced by cultural beliefs⁵. It is a fascinating subject and worth looking into in more depth to get an understanding of why some people will not take prescribed medication whether it is an intentional decision or a non-intentional action. The attitude and experience of the prescribing clinician can also influence a patient’s decision to adhere to a prescribed medication regimen⁶.

One of the strategies we tend to use to assess adherence is to look at the prescribing history – has the patient been prescribed adequate treatment (inhaled steroid-containing inhaler) to be taking it regularly as prescribed? Has the patient ordered excessive amounts of rescue medication (Salbutamol or Terbutaline) indicating poor symptom control? The national review of asthma deaths⁷ found these measures were potential contributors to mortality. Salbutamol overuse is the focus of the global social movement Asthma Right Care⁸, in part because of the recognised link between the overuse of rescue medication and the increase in asthma mortality and morbidity.

Another approach that can help when assessing adherence with inhaled corticosteroids is to measure fractional exhaled nitric oxide (FeNO). This measures eosinophilic airway inflammation which is a key component of most asthma types. If inhaled corticosteroids are taken regularly using the correct inhaler technique, this inflammation should be controlled unless a dose increase or addition of add-on therapy is required. If the patient is not taking regular treatment or is taking it using a poor technique, the airways will demonstrate this inflammation. If the test is undertaken following a clear explanation of what asthma is, how inhalers work and what the test will measure, the discussion on inhaler use has a good basis to work from – many people with asthma do not understand the disease process and how inhalers work so do not take them regularly. For those who are adherent with medication who can demonstrate good inhaler technique, a raised FeNO level may be an indication of the need to increase or add in medication.

Suboptimal inhaler technique is a common cause of increasing asthma symptoms and poor asthma control, yet is very common⁹. According to the systematic review published in 2016, only 31% of patients can use an inhaler correctly, and the inhaler technique has not improved over the past 40 years¹⁰.

Guidelines emphasize the importance of correct inhaler technique before escalating treatment², yet many healthcare practitioners are not confident or indeed competent in checking and coaching patients to optimise the use of inhalers. To address this, the UK Inhaler Group have produced a Standards and Competency document¹¹ to guide and encourage appropriate teaching and coaching of inhaler technique.

Checking the correct inhaler technique and assessing adherence with prescribed medication are 2 of the basics to check if a person presents with increasing asthma symptoms (not sudden acute asthma) especially if the person is found with raised FeNO levels.

The third element is to discuss and, where possible, eliminate asthma triggers. Whilst asthma has a natural variability which can often be unexpected and unpredictable, there are more obvious triggers that may be specific to the individual and will be known to increase asthma symptoms. There are a wide range of triggers from seasonal elements – increasing pollens in the spring and through summer, dampness and moulds in autumn, and respiratory infections in the winter – through exposure to perfumes and smoke, pets and animals, and house dust mites and many others besides.

Whilst some of these can also be unpredictable there are elements, especially as we go into winter for example, where a person knows from past experience that a particular season will ‘set them off’. The population with long-term health conditions are offered protection against some respiratory infections with vaccinations but viral infections have been found to cause up to 70% of asthma exacerbations¹². So, what can we do to protect our patients with asthma as we move into winter in addition to vaccine administration? During the COVID-19 pandemic where social distancing rules and mask-wearing were mandated, there was a reduction in admissions to hospitals from long-term respiratory conditions but this is not an acceptable strategy in the future.

What we can do is be sure that our patients have the appropriate medication in a device that they can and will use on a regular basis to optimise asthma control leading up to known predictable periods of likely exacerbation. The basis of this must be the patient’s understanding of what asthma is and an understanding of the expected effects of prescribed medication, supported with a personalised asthma action plan that will help patients to know their potential when asthma control is optimal, to recognise deterioration and know how to act and adjust medications safely, when to seek help and from whom.

There are various tools that will help in this patient journey such as placebo inhaler devices to practice and optimise inhaler technique, and diagrams and airway models to improve understanding of asthma. Measurement of lung function using a peak flow meter when a patient, as well as a comparator when a patient has increasing symptoms, is helpful. Measurement of FeNO is a valuable addition to the asthma toolbox to measure airway inflammation which will help the patient better understand what asthma is and how inhaled medication, in particular inhaled steroids, target inflammation. In symptomatic patients, it can open conversations around adherence and inhaler technique, guide step-up and step-down treatment decisions, and work as part of the toolkit to optimise asthma control.

Delve deeper into the impacts of winter and asthma care in our upcoming webinar with Carol Stonham; Battling Winter Wheezes: How Cold Weather Impacts Asthma and the Benefits of FeNO Monitoring, being held on Tuesday 9th January 2024 at 7pm. Learn how FeNO measurements play a pivotal role in monitoring and managing respiratory health during colder months.

References:

1. Why asthma is worse in winter [Internet]. Temple Health. 2021. [Cited Monday 13th November 2023]. Available from: https://www.templehealth.org/about/blog/why-asthma-worse-in-winter
2. British Thoracic Society, SIGN. BTS/SIGN Guideline for the management of asthma. Available from https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ [Last accessed 24.10.2023]
3. Brandstetter S, Finger T, Fischer W, et al. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD. Clin Transl Allergy. 2017;7(1):1–7. doi: 10.1186/s13601-017-0175-6
4. Ahmedani BK, Peterson EL, Wells KE, et al. Asthma medication adherence: the role of God and other health locus of control factors. Ann Allergy Asthma Immunol. 2013;110(2):75-79. e2. doi: 10.1016/j.anai.2012.11.006
5. Kaplan A, Mitchell PD, Cave AJ, et al. Effective asthma management: is it time to let the AIR out of SABA? J Clin Med 9(4):921. doi: 10.3390/jcm904092
6. van Boven JF, Ryan D, Eakin MN, et al. Enhancing respiratory medication adherence: the role of health care professionals and cost-effectiveness considerations. J Allergy Clin Immunol Pract 4(5):835–846. doi: 10.1016/j.jaip.2016.03.007
7. National review of asthma deaths. Why asthma still kills (2014). Available from https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills [Last accessed 24.10.2023]
8. Asthma Right Care (PCRS) available from https://www.pcrs-uk.org/campaign/asthma-right-care [Last accessed 24.10.23]
9. van der Palen J, Thomas M, Chrystyn H, Sharma RK, van der Valk pd, Goosens M, Wilkinson T, Stonham C, Chauhan AJ, Imber V, Svedsater H, Barnes NC. A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices npj Primary Care Respiratory Medicine volume 26, Article number: 16079 (2016) [last accessed 24.10.2023]
10. Sanchis J, Gich I, Pedersen S, et al Systematic review of errors in inhaler use: has patient technique improved over time?Chest 2016;150:394-406. doi:10.1016/j.chest.2016.03.041pmid:http://www.ncbi.nlm.nih.gov/pubmed/270607 26
11. UK Inhaler Group (2016, reviewed 2019) Inhaler Standards and Competency Document. Available from https://www.ukinhalergroup.co.uk/uploads/s4vjR3GZ/InhalerStandardsMASTER.docx 2019V10final.pdf [Last accessed 24.10.2023]
12. Hammond C, Kurten M, Kennedy JL. Rhinovirus and asthma: A storied history of incompatibility. Curr Allergy Asthma Rep. 2015;15:502.

As winter draws in, the NHS braces for an influx of patients infected with common respiratory viruses. For those with respiratory conditions, such as the 5.4 million asthma sufferers in the UK, the colder months pose an especially daunting threat.¹ Constricted airways, breathlessness, and tightness of the chest are typical yet distressing symptoms of asthma, an inflammatory disorder affecting around 9% of the population and capable of increasing vulnerability to respiratory infections.^1,2

Beyond the physical and mental strain caused by asthma, a DALY rate of 350 per 100,000 indicates a significant burden of asthma-related disability in the UK population.³ This is reflected in the reported 60,000 hospital admissions and 200,000 bed days for asthma sufferers each year.¹ Asthma can also be life-threatening, with asthma attacks claiming the lives of three people each day.¹

The human toll of asthma has led to a significant economic burden. This year, the direct cost of asthma in England – encompassing NHS expenses, the impact of greenhouse gas emissions, and patient travel costs – has exceeded £1.2 billion.¹ Collectively, lung conditions, including asthma, place an annual £9.6 billion burden on the NHS and exacerbate winter healthcare pressures, as individuals with these conditions are more susceptible to respiratory illnesses and cold weather.¹ Asthma has become more than a personal health concern; it is a public health and economic crisis.

Compounding a Crisis: Inadequate Diagnostic Testing Impedes Effective Decision-Making

A report published in 2023 by the British Charity Asthma + Lung UK highlights the concerning state of lung healthcare in England. Despite lung disease being the third leading cause of death, individuals suffering from breathlessness frequently wait years for a formal diagnosis, while others remain undiagnosed or are misdiagnosed.¹ One study found that an asthmatic diagnosis could not be established in over 30% of adults who had previously received positive diagnoses.⁴ The scale of this issue is brought into focus when realizing that an estimated 750,000 people are misdiagnosed as asthmatic in England, and attendant financial repercussions are estimated at £132 million each year.¹

The reasons behind these apparent oversights are complex. One contributing factor involves funding restrictions and a lack of accessibility to diagnostic tests, undermining the veracity of primary care diagnoses. As uncovered in a PwC analysis, current deficiencies in testing are estimated to cost England £2.2 billion, primarily due to preventable hospital stays and treatments.⁵

To recoup some of these costs and alleviate pressure on the NHS, Asthma + Lung UK proposed the following measures. By fully funding diagnostic testing such as FeNO, reinstating nationwide spirometry, and maximizing the potential of community diagnostic centers and primary care for diagnoses, £307 million could be saved, and 273,000 beds could be made available – with over a third of these during the critical winter period. This figure dwarfs the £250 million in emergency funds that the UK government set aside to create 5,000 extra NHS hospital beds for this winter.¹

FeNO Testing: Tackling the Burden of Lung Conditions, One Breath at a Time

As one of the three recommendations proposed by Asthma + Lung UK, improving diagnostic testing appears realistically achievable. NICE recommends a single objective test for measuring airway inflammation in the diagnosis of asthma, fractional exhaled nitric oxide (FeNO).⁶ This test works by measuring nitric oxide, a naturally occurring gas produced by cells lining the airways to help combat inflammation. In individuals with respiratory conditions, especially asthma, there is often increased production of nitric oxide due to localized inflammation. During a FeNO test, the individual breathes into a specialized device, such as the NObreath® by Bedfont Scientific Ltd, which is designed to capture and analyze its nitric oxide content. With extreme sensitivity, the device measures the concentration of nitric oxide in parts per billion. Through reading the output of the device, valuable information about the degree of inflammation in the individual’s airways can be discerned. Higher FeNO levels are indicative of greater airway inflammation, which is often associated with conditions like asthma.⁵

The NObreath®, developed by Bedfont Scientific Ltd., is a non-invasive FeNO monitor suitable for both adult and child patients. Conforming to ATS & ERS guidelines, the NObreath® works using an easy exhale-only technique and on-screen visual motivation. After a breath sample is collected and analyzed, airway inflammation can be assessed, and responses to treatment can be monitored. Furthermore, a patient interpretation guide streamlines result analysis, enabling healthcare providers to make informed decisions.⁷

While the NObreath® offers a simple and cost-effective solution to asthma diagnosis, FeNO tests and solutions essential to accurately evaluating lung health remain largely unavailable in primary care.^5,7 A comprehensive analysis conducted by the PwC suggests that if FeNO tests were to be made universally accessible to GPs across England, optimization of asthma treatment could save around £100 million.¹ Such a finding not only underscores the cost-effectiveness of FeNO testing but emphasizes its potential to enhance patient outcomes by ensuring accurate diagnoses and tailored treatments.

A Nation Blue in the Face: Heeding the Call for Improved Diagnostic Testing

The asthma crisis in England is a multifaceted challenge involving misdiagnoses and financial strain on the NHS. FeNO testing represents a solution that can aid in the accurate diagnosis of lung conditions, such as asthma, and save millions of lives when made widely available to GPs across the country and integrated into primary care. It is crucial that everyone suspected of lung conditions, such as asthma, has access to FeNO tests and that those who undergo testing receive precise diagnoses.

By embracing FeNO testing as a cornerstone of asthma management, we can significantly improve the quality of life for asthma sufferers, reduce healthcare costs, and alleviate the burden on the NHS. The time to act is now for the benefit of patients and the healthcare system nationwide. Contact Bedfont Scientific Ltd. to find out what solutions are available to aid in this journey to more accessible testing.

References and further reading

1. Saving Your Breath: How Better Lung Health Benefits Us All. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/saving-your-breath-report
2. Sharma S, et al. (2022). Vulnerability for Respiratory Infections in Asthma Patients: A Systematic Review. Cureus. http://doi.10.7759/cureus.28839
3. Nunes C, et al. (2017). Asthma costs and social impact. Asthma Research and Practice. http://doi.10.1186/s40733-016-0029-3
4. Aaron SD, et al. (2017). Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. http://doi.10.1001/jama.2016.19627
5. ‘Abysmal’ lack of testing for lung conditions is forcing GPs to play a ‘guessing game’ with diagnosis. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/media/press-releases/abysmal-lack-testing-lung-conditions-forcing-gps-play-guessing-game-diagnosis (Accessed on 09 October 2023).
6. Asthma: diagnosis, monitoring and chronic asthma management. NICE. Available at: https://www.nice.org.uk/guidance/ng80/chapter/Recommendations#objective-tests- for-diagnosing-asthma-in-adults-young-people-and-children-aged-5-and-over (Accessed on 09 October 2023).
7. Nobreath. Available at: https://www.nobreathfeno.com/us/ (Accessed on 09 October 2023).

Harnessing the Power of FeNO Monitoring to Combat Lung Conditions – A Vital Step in Addressing the UK’s Lung Health Crisis

A new report from PwC commissioned by Asthma+Lung UK has highlighted the alarming crisis surrounding Lung Health in the UK. Sarah Woolnough, CEO of Asthma+Lung UK, said lung conditions were the third biggest killer in the UK, with the report finding that due to the lack of testing, such as FeNO monitoring, patients can also be wrongly diagnosed and an estimated 750,000 people in England are misdiagnosed with asthma, costing the NHS an estimated £132 million every year¹.

Fractional Exhaled Nitric Oxide (FeNO) is a non-invasive medical test that measures the level of nitric oxide in a person’s breath. It is a pivotal advancement in asthma care, offering precise insights into airway inflammation. By facilitating accurate diagnoses, personalising treatment plans, and enabling ongoing monitoring of asthma control, FeNO empowers healthcare providers to optimise medication use, reduce exacerbations, and enhance patient engagement. This transformative tool not only improves the quality of life for individuals with asthma but also contributes to more effective, cost-efficient healthcare management, ultimately making a profound impact on the battle against this chronic respiratory condition.

Carol Stonham MBE, RN, MSc, Queen’s Nurse, and Policy Lead PCRS, explains, “Making an accuratediagnosis of asthma relies on taking an accurate history and then performing appropriate tests to confirm the diagnosis. Spirometry (a test of lung function) was stopped during the pandemic and hasbeen very slow to restart. FeNO testing provides a valuable piece of the jigsaw to confirm whether a person has asthma (or not). It is a very quick test to perform and most people find it easy to do. The basis of asthma is airway inflammation which is what the FeNO test gives an indication of. It helps confirm a diagnosis quickly and easily and helps the patient better understand their condition and how inhalers work to treat the condition. It helps clinicians make the correct diagnosis in a timely way and get the person onto the correct treatment pathway avoiding unnecessary hospital admission and life-threatening asthma attacks.”

Jason Smith, Managing Director at Bedfont Scientific, comments, “As a leading manufacturer of breath analysis medical devices, we understand the pivotal role that innovation plays in enhancing patient care and healthcare efficiency. FeNO testing is a prime example of such innovation. We remain committed to advancing respiratory care and hope that in working towards our mission to make healthcare more accessible, our NObreath® FeNO monitor can help make a positive impact on the lives of individuals living with asthma.”

Livio Gagliardi, Acting Managing Director at Intermedical, adds, “As the official UK distributor for NObreath®, we understand the significance of accessibility and affordability. We take pride in offering a flexible three-year rental plan for the NObreath® FeNO device. Our aim is to support practices and Primary Care Networks, regardless of their size or testing volume, in ensuring equal access to FeNO testing for their patients. We are well aware of the financial constraints faced by healthcare providers and patients alike.”“What sets us apart is our democratic cost per test pricing policy. We do not penalise smaller practices; instead, we maintain a low fixed cost per test, regardless of the volume of tests conductedper year. This means that even the smallest practices can benefit from our cost-effective solution. Our rental program for the NObreath® FeNO device serves as a crucial link, as we actively strive to narrow the gap and make advanced respiratory care accessible to everyone.”

The full report can be found here: https://www.asthmaandlung.org.uk/saving-your-breath

To contact Intermedical, please call 01732 522444 or email sales@intermedical.co.uk

References

1. Asthma+Lung UK. Saving Your Breath: How Better Lung Health Benefits Us All. September 2023. Available from: https://www.asthmaandlung.org.uk/saving-your-breath-report

Access to prevention and treatment for all. Leave no one behind:

Organised by the Forum of International Respiratory Societies (FIRS) since 2016, World Lung Day is a time for everyone to take a look at what we can do individually and as a society, to work toward clean air and healthy lungs for all. Asthma is closely related to World Lung Day because it is one of the major lung health conditions that the day seeks to address.

Under-diagnosis of asthma

In 2019, asthma affected an estimated 262 million people worldwide¹ and led to 455,000 deaths globally². A study completed by Nolte et al. in 2006 involved 10,877 participants aged 14-44 years old, 11% (1,149) of whom had previously reported asthma symptoms. After further assessment provided by Global Initiative for Asthma (GINA) recommendations, 43% (493) of the 11% were diagnosed with asthma, of which a further 50% (246) had not been diagnosed before³.

When asthma remains undiagnosed or receives inadequate treatment, it can lead to stress, anxiety, or depression, as well as lung infections, hindered growth and delayed puberty in children. Additionally, it can escalate to critical asthma attacks that can be life-threatening⁴.

FeNO testing and asthma:

The use of FeNO testing, in conjunction with a comprehensive clinical history and additional examinations, contributes to more efficient asthma diagnosis and enhances patient care. Furthermore, it enables the monitoring of patients’ responses to asthma interventions.

FeNO testing can be completed within seconds and provides nearly instantaneous results, compared to traditional testing like spirometry with a bronchodilator test. Thereby ensuring a larger number of individuals receive appropriate treatment for their specific conditions, leading to reduced medication wastage⁵. In England, a two-year programme from 2021-2023 showed an estimated 58,000 people with newly diagnosed asthma received faster treatment, after more than 1,200 FeNO devices entered primary care⁶, highlighting the impact FeNO testing can have on asthma care.

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

References:

1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, and Abdollahi M. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020;396(10258):1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.
2. Asthma [Internet] World Health Organization. 2023. [Cited 24^th August 2023]. Available from: https://www.who.int/news-room/fact-sheets/detail/asthma
3. Nolte H, Nepper-Christensen S, and Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respiratory medicine. 2006;100(2):354-362. PMID: 16005621. DOI: 10.1016/j.rmed.2005.05.012
4. The Global Asthma Report 2018 [Internet]. 2018. [Cited 25^th August 2023]. Available from: http://globalasthmareport.org/2018/index.html
5. Improving access to FeNO testing in primary care [Internet]. 2023. [Cited 25^th August 2023]. Available from: https://www.ahsnnetwork.com/programmes/respiratory-disease/bettering-access-to-feno-testing-in-primary-care/
6. New report shows impact of FeNO national programme on asthma care in England [Internet] Primary Care Respiratory Society. 2023. [Cited 24^th August 2023]. Available from: https://www.pcrs-uk.org/news/new-report-shows-impact-feno-national-programme-asthma-care-england#:~:text=During%20the%20two%2Dyear%20programme,in%20primary%20care%20in%20England.

Organized by the Global Initiative for Asthma (GINA), World Asthma Day is an annual awareness day aimed at raising awareness of asthma and improving healthcare, with this year’s theme focusing on ‘Asthma care for All’¹. Thanks to over 15 years of experience in FeNO monitoring, Bedfont® Scientific Ltd has developed a FeNO breath analysis device that can aid in the diagnosis and management of asthma. Bedfont® is working to increase access to FeNO monitoring worldwide through its dedicated network of distributors and Key Opinion Leaders.

Did you know that worldwide asthma affected an estimated 262 million people in 2019 and caused 455,000 deaths?² The central process within asthma and many other lung diseases is airway inflammation, and being able to detect airway inflammation levels and monitor a patient’s response to treatment is regarded as a gold standard in the management of respiratory diseases.

When airways are inflamed Nitric Oxide (NO) is naturally produced by your body to help combat inflammation. This production of NO is often found to be higher in inflammatory conditions such as asthma, and an innovative way of detecting and managing such conditions is done through FeNO monitoring. Two funded projects in the UK have presented data from a staff survey in primary care that shows that 83% of survey respondents have felt that FeNO testing has improved confidence levels when diagnosing asthma, and 90% believe that access to FeNO testing has supported the diagnosis of asthma with patients³.

Fractional exhaled Nitric Oxide (FeNO) is a measure of the concentration of NO gas particles in exhaled breath, expressed in parts per billion (ppb). The NObreath® FeNO device by Bedfont® Scientific Ltd. is easy to use with its simple exhale-only technique and on-screen visual motivation. With over 10 years of clinical use featuring in many studies worldwide, the NObreath® FeNO device aids in the diagnosis & management of asthma for both adult and child patients, giving you the ability to also store up to 25 results in up to 50 patient profiles with full graph results.

With a handheld, portable, easy-to-use device, Bedfont® is helping to break FeNO accessibility barriers. Previously FeNO breath analysis has been expensive, however, we have made it more cost-effective by having low-cost mouthpieces with a long shelf-life. The NObreath® includes a 5-year warranty on the device and sensor, and we have also simplified the service and maintenance options. To find out how you can support your patients with FeNO monitoring to improve ‘Asthma care for All’ this World Asthma Day, visit https://www.nobreathfeno.com.

References:

1. Rurey K. 2023 World Asthma Day – Global Initiative for Asthma [Internet]. GINA. 2023 [cited 2023Apr4]. Available from: https://ginasthma.org/2023-world-asthma-day/

2. Asthma [Internet]. World Health Organization. World Health Organization; [cited 2023Apr17]. Available from: https://www.who.int/news-room/fact-sheets/detail/asthma

3. Feno testing in Primary Care [Internet]. West of England Academic Health Science Network. 2023 [cited 2023Apr17]. Available from: https://www.weahsn.net/our-work/case-study/feno-testing-in-primary-care/

When a person’s airways are not working correctly, the resulting difficulty in breathing can be detrimental to everyday activities and lead to more serious health risks. According to the World Health Organization, asthma – a chronic condition where a person’s airways are narrow and inflamed, making airflow difficult – is a health condition that affected over 260 million people worldwide in 2019¹. On May 3rd, 2022, asthma care advocates celebrated World Asthma Day, which is dedicated to raising awareness of asthma worldwide. A World Health Organization collaborative organization called Global Initiative for Asthma, or GINA, selected the theme ‘Closing the Gap’ to highlight many gaps in asthma care which are an issue all year-round.

There are multiple gaps in present-day asthma care that can be addressed to improve the general health of people with asthma. Through education services and user-friendly technology such as the NObreath^® monitor, life sciences company Bedfont^® Scientific Ltd. covers many topics that close the gaps in asthma care that GINA outlines. This blog post will highlight how FeNO monitoring with NObreath^® solves some of these issues.

How the NObreath^® Monitor Addresses Gaps in Asthma Care Access and Delivery

Fractional exhaled nitric oxide (FeNO) levels can be used as an indicator of airway inflammation, a common sign of asthma. The NObreath^® is a fractional exhaled nitric oxide test monitor that easily and non-invasively measures expired breath nitric oxide³. This monitor is useful because it helps identify if a person requires regular asthma treatment such as medication.
As NObreath^® is simple to use and is non-invasive, this device closes the gap between healthcare providers prescribing inhalers and a patient’s ability to use asthma care devices. Furthermore, this technology can be programmed for a range of patients, from children to adults, also addressing gaps between care for various age groups^2,3.
NObreath^® also bridges gaps in equal access to asthma care, between socioeconomic groups, and in different communities with a wide range of wealth diversity. The device is available for purchase in multiple countries, has no limits on its use, and operates with low-cost mouthpieces that have a long lifetime, making NObreath^® a cost-effective solution to asthma care⁴.

How Bedfont’s Education Portal Addresses Gaps in Asthma Care Communication, Education, and Awareness

Bedfont^® Scientific Ltd. also created an online education portal around NObreath^® that helps solve other challenges to asthma care outlined by GINA. The portal includes various informational and training videos surrounding the device and effective asthma care that boosts communication and awareness about asthma to both people with asthma and health care providers alike.
The website includes videos explaining FeNO and interpreting FeNO test results in the context of asthma care which connects scientific evidence and education to the actual delivery of care^2,5. Other videos cover topics such as explaining how to take a test, change parts, and charge the NObreath^® monitor. These bolster the machine’s usability and accessibility and the general awareness of asthma as a chronic disease for people with asthma, the general public, and health care professionals^2,5.
Bedfont^® Scientific Ltd. Provides Solutions to Asthma Care Challenges
World leaders in breath analysis, Bedfont^® Scientific Ltd. addresses multiple gaps outlined by GINA for World Asthma Day 2022 through the userfriendly NObreath^® FeNO monitor and an education portal covering scientific concepts and practical learning.

References:
1. World. (2021, May 3rd). Asthma. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/asthma
2. World Asthma Day 2022 – Global Initiative for Asthma – GINA. (2022, April 6th). Global Initiative for Asthma – GINA. https://ginasthma.org/world-asthma-day-2022/
3. Bedfont^® Scientific Ltd. (2022). Bedfont.com. https://www.bedfont.com/nobreath
4. NObreath^® | Bedfont^® GmbH. (2021, April 15th). Bedfont® GmbH. https://eurostore.bedfont.com/product/nobreath-2nd-generation/
5. Educational Portal – NObreath. (2018). NObreath. https://www.nobreathfeno.com/educational-portal/