The Trouble with Diagnosing Asthma
Approximately 339 million people across the globe suffer from asthma, and asthma-related deaths affect the lives of three families every day. Of these, up to two-thirds of deaths due to asthma attacks are preventable.
Inadequate treatment and poor management as well as issues with diagnosis contribute to the morbidity and mortality in asthma patients. Even today, up to 30% of asthma patients are misdiagnosed and subsequently do not receive the care they need to manage their disorder.
For example, in the UK more than 120,000 asthma patients may be at risk of a life-threatening asthma attack due to unsafe prescribing practices, and someone is admitted to hospital every eight minutes because of an asthma attack.
Diagnosing asthma can be challenging in some cases, considering that the symptoms of some diseases present themselves in a similar way to asthma. Conventional diagnostic techniques, including peak flow and spirometry, provide inadequate insight as many of these strategies only evaluate airflow rather than airway inflammation. The lack of an inflammation assessment in diagnostics is a leading contributor to misdiagnosis in this patient population.
Using FeNO to Diagnose Asthma
Over the past decade, scientific discoveries have advanced the understanding of asthma, particularly biomarkers contained in the exhaled breath. Fractional exhaled nitric oxide (FeNO) in exhaled breath represents one objective biomarker test that can identify asthma patients who are more likely to experience benefit from corticosteroids.
Nitric oxide is produced naturally in the body to combat inflammation, the presence of inflammation in the airway causes the production of nitric oxide in the lungs, which is then exhaled. Asthma is characterized by inflammation of the airways and so detecting airway inflammation as well as evaluating an asthmatic’s response to treatment can be helpful for effectively managing the disorder.
FeNO has been shown to be a safe and complementary objective method for the quantification of airway inflammation specifically for asthma patients, and reliability of this biomarker is also high according to both animal and human studies.
FeNO is particularly useful when evaluating airway inflammation to distinguish between people with asthma and those with allergen-induced airway inflammation without airway hyper-reactivity and can help in the identification of patients with antigen-specific T-helper cells type 2, type 2 allergic and eosinophilic inflammation.
By clearly segmenting and correctly diagnosing patients with similar symptoms the best course of treatment can be prescribed reducing time to a complete diagnosis and reducing over-prescription of medication, while safeguarding patient safety.
FeNO for Asthma Monitoring
Along with asthma diagnosis, FeNO measurements are also useful for the long-term management of asthmatic symptoms.
Regular monitoring can determine whether patients’ have adhered to treatment, and FeNO monitoring has been demonstrated as a useful non-invasive, adjunctive method to evaluate the quality of asthma control in steroid-naïve asthmatics as well as asthmatics receiving treatment. This allows healthcare professionals to adjust corticosteroid doses based on the inflammation levels and feedback from the patient.
Monitoring FeNO levels can also assist in identifying patients who are candidates for biologic treatment, and potentially identify patients as candidates for future treatments.
Implementing FeNO Testing
Although some clinicians have been hesitant to use FeNO measurements since its introduction into the NICE guidelines, the adoption of this test may facilitate faster and more accurate diagnosis while improving treatment outcomes.
Assessments can be made with a single test, with the FeNO levels over the NICE recommended guideline of ≥40 parts per billion as a marker for a positive diagnosis. The test is rapid and completely non-invasive, suitable for both adults and children and is associated with excellent patient compliance.
The NObreath FENO Breath Test Monitor from Bedfont Scientific
Since 1976, Bedfont Scientific has designed and produced exhaled breath and gas monitoring instruments. Bedfont Scientific’s NObreath® FENO Breath Test Monitor measures FeNO levels that has been clinically tested for accuracy and conforms to ERS/ATS guidelines.
Until recently, FeNO testing has been too costly to perform in routine clinical practice. However, advancements in the field of medical technology and devices from Bedfont Scientific have improved the development of validated, affordable testing of FeNO in patients with asthma or suspected asthma.
The NObreath® FeNO Breath Test Monitor is a portable device that requires just an inhale and an exhale to register FeNO levels. Providing unlimited FeNO testing, with profiles built in for both adults and children, the NObreath® monitor is a low-cost solution with easy-to-use, reliable and accurate results.
- Global Asthma Report 2018
- Asthma UK annual survey 2017