Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care

David Price, Dermot Ryan, Annie Burden, Julie Von Ziegenweidt, Shuna Gould, Daryl Freeman, Kevin Gruffydd-Jones, Anne Copland, Clifford Godley, Alison Chisholm, Mike Thomas

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Abstract

BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation and good predictor of corticosteroid response.

AIM: To evaluate how FeNO is being used to guide primary care asthma management in the United Kingdom (UK) with a view to devising practical algorithms for the use of FeNO in the diagnosis of steroid-responsive disease and to guide on-going asthma management.

METHODS: Eligible patients (n = 678) were those in the Optimum Patient Care Research Database (OPCRD) aged 4-80 years who, at an index date, had their first FeNO assessment via NIOX MINO® or Flex®. Eligible practices were those using FeNO measurement in at least ten patients during the study period. Patients were characterized over a one-year baseline period immediately before the index date. Outcomes were evaluated in the year immediately following index date for two patient cohorts: (i) those in whom FeNO measurement was being used to identify steroid-responsive disease and (ii) those in whom FeNO monitoring was being used to guide on-going asthma management. Outcomes for cohort (i) were incidence of new ICS initiation at, or within the one-month following, their first FeNO measurement, and ICS dose during the outcome year. Outcomes for cohort (ii) were adherence, change in adherence (from baseline) and ICS dose.

OUTCOMES: In cohort (i) (n = 304) the higher the FeNO category, the higher the percentage of patients that initiated ICS at, or in the one month immediately following, their first FeNO measurement: 82%, 46% and 26% of patients with high, intermediate and low FeNO, respectively. In cohort (ii) (n = 374) high FeNO levels were associated with poorer baseline adherence (p = 0.005) but greater improvement in adherence in the outcome year (p = 0.017). Across both cohorts, patients with high FeNO levels were associated with significantly higher ICS dosing (p < 0.001).

CONCLUSIONS: In the UK, FeNO is being used in primary practice to guide ICS initiation and dosing decisions and to identify poor ICS adherence. Simple algorithms to guide clinicians in the practical use of FeNO could improved diagnostic accuracy and better tailored asthma regimens.

Original languageEnglish
Pages (from-to)37
JournalClinical and Translational Allergy
Volume3
Issue number1
DOIs
Publication statusPublished - 7 Nov 2013

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Nitric Oxide
Asthma
Steroids
Primary Health Care
Patient Care
Adrenal Cortex Hormones
Biomarkers
Databases
Inflammation

Keywords

  • fractional exhaled nitric oxide (FeNO)
  • practical guidance
  • diagnosis
  • on-going asthma management
  • steroid-responsive disease

Cite this

Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care. / Price, David; Ryan, Dermot; Burden, Annie; Von Ziegenweidt, Julie; Gould, Shuna; Freeman, Daryl; Gruffydd-Jones, Kevin; Copland, Anne; Godley, Clifford; Chisholm, Alison; Thomas, Mike.

In: Clinical and Translational Allergy, Vol. 3, No. 1, 07.11.2013, p. 37.

Research output: Contribution to journalArticle

Price, D, Ryan, D, Burden, A, Von Ziegenweidt, J, Gould, S, Freeman, D, Gruffydd-Jones, K, Copland, A, Godley, C, Chisholm, A & Thomas, M 2013, 'Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care', Clinical and Translational Allergy, vol. 3, no. 1, pp. 37. https://doi.org/10.1186/2045-7022-3-37
Price, David ; Ryan, Dermot ; Burden, Annie ; Von Ziegenweidt, Julie ; Gould, Shuna ; Freeman, Daryl ; Gruffydd-Jones, Kevin ; Copland, Anne ; Godley, Clifford ; Chisholm, Alison ; Thomas, Mike. / Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care. In: Clinical and Translational Allergy. 2013 ; Vol. 3, No. 1. pp. 37.
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keywords = "fractional exhaled nitric oxide (FeNO), practical guidance, diagnosis, on-going asthma management, steroid-responsive disease",
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note = "Acknowledgements We thank Robin Taylor for his informative thinking and publications on FeNO, which have helped to influence and direct the thinking of the authors. Funding Extraction of the real-life dataset was funded by Research in Real Life Limited, the analysis of the dataset and the writing of this manuscript were co-funded (50:50) by Research in Real Life Limited and Aerocrine.",
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T1 - Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive disease and guide asthma management in routine care

AU - Price, David

AU - Ryan, Dermot

AU - Burden, Annie

AU - Von Ziegenweidt, Julie

AU - Gould, Shuna

AU - Freeman, Daryl

AU - Gruffydd-Jones, Kevin

AU - Copland, Anne

AU - Godley, Clifford

AU - Chisholm, Alison

AU - Thomas, Mike

N1 - Acknowledgements We thank Robin Taylor for his informative thinking and publications on FeNO, which have helped to influence and direct the thinking of the authors. Funding Extraction of the real-life dataset was funded by Research in Real Life Limited, the analysis of the dataset and the writing of this manuscript were co-funded (50:50) by Research in Real Life Limited and Aerocrine.

PY - 2013/11/7

Y1 - 2013/11/7

N2 - BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation and good predictor of corticosteroid response.AIM: To evaluate how FeNO is being used to guide primary care asthma management in the United Kingdom (UK) with a view to devising practical algorithms for the use of FeNO in the diagnosis of steroid-responsive disease and to guide on-going asthma management.METHODS: Eligible patients (n = 678) were those in the Optimum Patient Care Research Database (OPCRD) aged 4-80 years who, at an index date, had their first FeNO assessment via NIOX MINO® or Flex®. Eligible practices were those using FeNO measurement in at least ten patients during the study period. Patients were characterized over a one-year baseline period immediately before the index date. Outcomes were evaluated in the year immediately following index date for two patient cohorts: (i) those in whom FeNO measurement was being used to identify steroid-responsive disease and (ii) those in whom FeNO monitoring was being used to guide on-going asthma management. Outcomes for cohort (i) were incidence of new ICS initiation at, or within the one-month following, their first FeNO measurement, and ICS dose during the outcome year. Outcomes for cohort (ii) were adherence, change in adherence (from baseline) and ICS dose.OUTCOMES: In cohort (i) (n = 304) the higher the FeNO category, the higher the percentage of patients that initiated ICS at, or in the one month immediately following, their first FeNO measurement: 82%, 46% and 26% of patients with high, intermediate and low FeNO, respectively. In cohort (ii) (n = 374) high FeNO levels were associated with poorer baseline adherence (p = 0.005) but greater improvement in adherence in the outcome year (p = 0.017). Across both cohorts, patients with high FeNO levels were associated with significantly higher ICS dosing (p < 0.001).CONCLUSIONS: In the UK, FeNO is being used in primary practice to guide ICS initiation and dosing decisions and to identify poor ICS adherence. Simple algorithms to guide clinicians in the practical use of FeNO could improved diagnostic accuracy and better tailored asthma regimens.

AB - BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation and good predictor of corticosteroid response.AIM: To evaluate how FeNO is being used to guide primary care asthma management in the United Kingdom (UK) with a view to devising practical algorithms for the use of FeNO in the diagnosis of steroid-responsive disease and to guide on-going asthma management.METHODS: Eligible patients (n = 678) were those in the Optimum Patient Care Research Database (OPCRD) aged 4-80 years who, at an index date, had their first FeNO assessment via NIOX MINO® or Flex®. Eligible practices were those using FeNO measurement in at least ten patients during the study period. Patients were characterized over a one-year baseline period immediately before the index date. Outcomes were evaluated in the year immediately following index date for two patient cohorts: (i) those in whom FeNO measurement was being used to identify steroid-responsive disease and (ii) those in whom FeNO monitoring was being used to guide on-going asthma management. Outcomes for cohort (i) were incidence of new ICS initiation at, or within the one-month following, their first FeNO measurement, and ICS dose during the outcome year. Outcomes for cohort (ii) were adherence, change in adherence (from baseline) and ICS dose.OUTCOMES: In cohort (i) (n = 304) the higher the FeNO category, the higher the percentage of patients that initiated ICS at, or in the one month immediately following, their first FeNO measurement: 82%, 46% and 26% of patients with high, intermediate and low FeNO, respectively. In cohort (ii) (n = 374) high FeNO levels were associated with poorer baseline adherence (p = 0.005) but greater improvement in adherence in the outcome year (p = 0.017). Across both cohorts, patients with high FeNO levels were associated with significantly higher ICS dosing (p < 0.001).CONCLUSIONS: In the UK, FeNO is being used in primary practice to guide ICS initiation and dosing decisions and to identify poor ICS adherence. Simple algorithms to guide clinicians in the practical use of FeNO could improved diagnostic accuracy and better tailored asthma regimens.

KW - fractional exhaled nitric oxide (FeNO)

KW - practical guidance

KW - diagnosis

KW - on-going asthma management

KW - steroid-responsive disease

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DO - 10.1186/2045-7022-3-37

M3 - Article

VL - 3

SP - 37

JO - Clinical and Translational Allergy

JF - Clinical and Translational Allergy

SN - 2045-7022

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ER -