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Respir Med. 2014 Jun;108(6):830-41. doi: 10.1016/j.rmed.2014.02.005. Epub 2014 Feb 15.

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

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Department of Respiratory Medicine and Allergology, Skane University Hospital, 22185 Lund, Sweden. Electronic address:
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Respiratory Medicine and Allergology, Skane University Hospital, 22185 Lund, Sweden; Department of General Practice & QPS-NL, Groningen, The Netherlands.
Pulmonary Research Institute at Lung Clinic Grosshansdorf, Germany.
Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
Faculty of Medicine, University of Verona, Italy; Department of Paediatrics, Policlinico GB Rossi, Verona, Italy.
University of Aberdeen, UK.
University Paris Descartes, Respiratory and Intensive Care Medicine Department, Cochin Hospital Group, Paris, France.
Fundacion Jimenez Diaz, Allergy Service and CIBERES, Institute Carlos III, Madrid, Spain.
University of Southampton, UK.
National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK.


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; Eosinophil; Health economy; Therapy monitoring

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