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Current evidence and future research needs for FeNO measurement in respiratory diseases

Current evidence and future research needs for FeNO measurement in respiratory diseases
Current evidence and future research needs for FeNO measurement in respiratory diseases
Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.

breath test, diagnosis, therapy monitoring, health economy, eosinophil
Bjermer, L.
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Alving, K.
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Diamant, Z.
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Magnussen, H.
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Pavord, I.
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Piacentini, G.
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Price, D.
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Roche, N.
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Sastre, J.
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Thomas, M.
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Usmani, O.
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Bjermer, L.
5e4be066-ed75-4f31-9e28-dc502cc7c0a4
Alving, K.
4074a105-8005-47cd-a00c-182e1ce25dad
Diamant, Z.
b5d27a33-e484-4e12-b75c-202a04a2e2e2
Magnussen, H.
d745e23b-9e77-42b2-bdf8-18252730e1c1
Pavord, I.
6a96cdc5-1713-4e2a-925f-7caf6134c717
Piacentini, G.
d7165a65-3924-41cc-80f4-c4d322e2cfa6
Price, D.
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Roche, N.
0aa0a8aa-062e-4f49-897f-88ba1c195771
Sastre, J.
e7f3fcbb-bf40-429a-8219-b8a92778d53d
Thomas, M.
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Usmani, O.
6629fd11-478a-44f0-add1-b5be9dd6ad1e

Bjermer, L., Alving, K., Diamant, Z., Magnussen, H., Pavord, I., Piacentini, G., Price, D., Roche, N., Sastre, J., Thomas, M. and Usmani, O. (2014) Current evidence and future research needs for FeNO measurement in respiratory diseases. Respiratory Medicine. (doi:10.1016/j.rmed.2014.02.005).

Record type: Article

Abstract

Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.

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More information

Published date: 15 February 2014
Keywords: breath test, diagnosis, therapy monitoring, health economy, eosinophil
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 364992
URI: https://eprints.soton.ac.uk/id/eprint/364992
PURE UUID: 2b763b18-1199-4518-a4c9-a18dfdf5334b

Catalogue record

Date deposited: 19 May 2014 11:27
Last modified: 16 Jul 2019 21:05

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