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Asthma Diagnosis: Exploring FeNO Tests and Related Treatments

Asthma Diagnostic: Treatment Options and Beyond (Regarding FeNO Test)

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Asthma Diagnosis and Management: Discussing FeNO Tests and Beyond
Asthma Diagnosis and Management: Discussing FeNO Tests and Beyond

The FeNO (Fractional exhaled nitric oxide) test is a quick, non-invasive method used by doctors to support the diagnosis of asthma, especially in children aged 5 years and older, and adults. This test requires exhaling into a handheld device and inhaling slowly and deeply.

The diagnostic accuracy of the FeNO test varies depending on the population, but it generally offers good specificity, especially at higher FeNO levels.

In Children

For children, a normal FeNO reading is below 20 ppb, intermediate is 20-35 ppb, and high is more than 35 ppb. FeNO levels below 20 ppb indicate unlikely eosinophilic inflammation and corticosteroid responsiveness, whereas levels above 35 ppb suggest probable eosinophilic inflammation and likely responsiveness to corticosteroids. FeNO monitoring in children and adolescents can also predict asthma relapse after discontinuing inhaled corticosteroids, often before clinical symptoms appear.

In Adults

In adults, according to European Respiratory Society (ERS) 2022 guidelines, a FeNO cut-off of 40 parts per billion (ppb) balances sensitivity and specificity for asthma diagnosis, while a cut-off of 50 ppb has a high specificity >90%, strongly supporting asthma diagnosis. However, FeNO below 40 ppb does not exclude asthma, and elevated FeNO alone does not confirm it.

Several factors can affect the FeNO test results. Age is one such factor, with different cut-offs and interpretations used for children vs. adults. Eosinophilic airway inflammation, corticosteroid treatment, smoking status, atopy/allergic rhinitis, environmental factors, and technical and procedural aspects also influence the results.

The FeNO test is primarily useful to identify eosinophilic airway inflammation characteristic of asthma rather than general airway obstruction. It is complementary to pulmonary function tests.

An allergist may request a FeNO test to diagnose or monitor asthma or determine the effectiveness of anti-inflammatory steroid medications. The FeNO test can help medical professionals track levels of airway inflammation over time. It is a type of lung function test that measures the level of nitric oxide gas in exhaled air. High FeNO readings in both adults and children indicate airway inflammation that may be due to underlying asthma.

People should avoid certain factors at least 1 hour before their FeNO test, such as smoking, vaping, alcohol consumption, carbonated beverages, caffeine consumption, and consumption of highly processed foods. The guidelines for FeNO test results in adults and children differ.

Doctors may use FeNO test results to guide treatments for asthma, particularly for individuals with uncontrolled and persistent asthma, those requiring additional anti-inflammatory treatment, and those with a genetic predisposition to allergic diseases such as asthma, allergic rhinitis, and eczema. Cells produce nitric oxide gas in response to inflammation, particularly in certain types of asthma.

In conclusion, the FeNO test provides moderate sensitivity and high specificity for asthma diagnosis with specific cut-offs (40–50 ppb adults, 20–35 ppb children), and its accuracy improves when combined with clinical assessment and other lung function tests. Multiple biological and technical factors must be considered to interpret FeNO levels accurately.

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