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Managing asthma with FeNO for better health

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Airway inflammation is a characteristic of asthma and is one of the main causes of the asthma attacks, or flare-ups, that can have such a devastating effect on people's lives. We're talking about the use of FeNO (fractional exhaled nitric oxide) today, and how measuring and monitoring your FeNO levels can help reduce the impact asthma has on your quality of life.

What does good asthma management look like?

The most important goals in asthma management are reducing the associated risks and keeping your symptoms under control so you feel better. Risks include potentially fatal asthma attacks and the side-effects of medication.1 In addition, frequent asthma attacks can cause changes to your airways. For example, the airways may become narrower and it can be harder to breathe, so it's important to manage your asthma well.

Reducing asthma attacks is the top priority. Did you know flare-ups are the second most common reason that children go to hospital and the fourth most common reason in adults?2 You can see how the cost of asthma can be huge in terms of missed days of school and work, not to mention the expense to the healthcare system.1

Even patients who do not experience many symptoms are at risk of asthma attack so your doctor will look for any changes you can make for the better. This can be adjustments to medication, looking at other health issues you might have and the amount of exposure you have to environmental factors, such as tobacco smoke, air pollution and allergens. The amount of airway inflammation in your lungs can guide your doctor to make the right changes, which can be seen with a quick FeNO test. High FeNO is associated with a greater risk of asthma attack but watching your FeNO score with regular testing and seeing your number stabilise within a healthy range has been shown to reduce asthma flare-ups by up to 50%.3,4

Personal treatment

Asthma can be well-controlled when you work with your doctor on a cycle of assessment, adjustment and review.1 The dose of your regular controller medication, usually inhaled steroids, can be increased or decreased to a level that works for you, which your doctor will monitor as part of your asthma management.

FeNO testing is useful for both adult and childhood asthma. Scientists have found that patients who use FeNO as part of their asthma management plan experience fewer asthma attacks than those who do not.4 Studies have also shown that performing FeNO testing can help healthcare teams to safely reduce the dosage of asthma medication, and that monitoring asthma with FeNO can identify people with high levels of airway inflammation that would not otherwise be noticed.5,6 When your airway inflammation is tracked, your doctor can better tailor your treatment to your needs so you potentially avoid future asthma attacks.

Looking after you for the long term

Up to 80% of patients miss doses of their medication or use their inhaler incorrectly, which can mean the medication won't reach where it's needed. This can lead to a loss of control of airway inflammation and of course, greater risk of asthma attack.

The good news is, tracking your FeNO score can tell you what's happening inside your lungs so you and your doctor can spot any gaps in your care before something serious happens. FeNO levels are usually higher in patients who are not taking their medication or not using inhalers correctly and a FeNO number that's going up will let you know. One of the most recent studies into non-adherence (when patients don't take their medication as prescribed), found that FeNO levels reduce by up to 50% in just four days when patients take their medication properly.7

FeNO testing is safe, easy and can produce your results in less than two minutes. If you'd like to know more, take a look at the other resources on fenoandasthma.com and ask your healthcare teams for advice.

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Taking a test

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Supporting evidence:

1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2022 update.
2. Meltzer et al. Asthma burden in the United States: results of the 2009 Asthma Insight and Management survey. Allergy Asthma Proc. 2012;33(1):36-46.
3. Busse WW et al. Baseline FeNO as a prognostic biomarker for subsequent severe asthma exacerbations in patients with uncontrolled, moderate-to-severe asthma receiving placebo in the LIBERTY ASTHMA QUEST study: a post-hoc analysis. Lancet Respir Med. 2021;9(10):1165-1173.
4. Petsky HL et al. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-9.
5. Hanania NA et al. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Ann Allergy Asthma Immunol. 2018;120(4):414-418.
6. Wang K et al. Using fractional exhaled nitric oxide to guide step-down treatment decisions in patients with asthma: a systematic review and individual patient data meta-analysis. Eur Respir J. 2020;55(5):1902150.
7. Heaney LG et al. Medical Research Council UK Refractory Asthma Stratification Programme (RASP-UK). Remotely monitored therapy and nitric oxide suppression identifies nonadherence in severe asthma. Am J Respir Crit Care Med. 2019;199(4):454-464.