Asthma is one of the most common chronic conditions and, for sufferers, it can be terrifying if not managed properly. In the UK alone, 5.4m people are estimated to have the condition while, in the US, that figure is around 20m.
Across the globe, the World Health Organisation estimates there are 300m people suffering from asthma, with 250,000 annual deaths because of the disease. Within a decade, it is thought another 100m people will have the condition.
They are staggering figures, made all the more worrying when you consider that many asthma deaths are preventable. Asthma UK recently released the National Review of Asthma Deaths, which reported that almost half of asthma deaths could be prevented with better routine care.
Getting the correct diagnosis is the first step in any patient care journey. Currently, there is no single test which serves as a gold standard to diagnose asthma.
The condition must be diagnosed using a combination of family and symptom history along with a number of methods and assessments such as spirometry, which tests lung function.
But health professionals are now being urged to go further in the tests they carry out to determine whether a patient has asthma.
Testing Fractional Exhaled Nitric Oxide (FeNO)
The National Institute for Health and Care Excellence (NICE) has released new draft guidelines recommending that respiratory care professionals should carry out a simple breath test called a FeNO test to help diagnose asthma.
A FeNO test is carried out using a small handheld device, a little like a breathalyser, meaning it can be done by a doctor or nurse, or in a hospital-based setting. A patient simply blows into the device steadily for around 10-seconds before their physician interprets results on-the-spot.
The test gives information about ongoing inflammation in a patient’s airways. People with asthma tend to have higher FeNO levels than those without the condition. Analysing a patient’s FeNO results can help a physician to determine whether or not a patient has asthma.
Carrying our regular FeNO tests can provide health professionals with an extra tool to manage patients’ asthma.
A physician can use FeNO results to aid treatment decisions, tailoring the dosage of inhaled corticosteroids according to levels of inflammation. A high FeNO reading could lead to the stepping-up of treatment, potentially cutting the risk of a patient suffering an asthma attack.
Health professionals also state that carrying out FeNO tests allows them to have open and frank discussions with patients about treatment adherence. Asthma sufferers may not take the right dosage of medication, particularly if they are feeling well, or may not have the correct inhaler technique.
If a patient has unexpectedly high FeNO levels, that can open up discussions about treatment adherence and inhaler usage.
A wealth of research has now been carried out into the use of FeNO tests for the diagnosis and management of asthma.
Three recent studies all found that measuring how inflamed patients’ airways were by carrying out FeNO tests could cut down the number of asthma exacerbations suffered by as much as half.
With an ever-increasing body of research highlighting the benefits of FeNO testing for patients, experts and health organisations such as NICE championing the breath tests, it is likely more patients will be offered regular FeNO tests as part of the management of their asthma.
Blog written by Will Carroll – consultant paediatrician with a special interest in respiratory conditions working at Derby Hospitals NHS Foundations Trust