The Use of Fraction of Exhaled Nitric Oxide in Pulmonary Practice 

The measurement of the fractional concentration of exhaled nitric oxide (FeNO) is a convenient, noninvasive, point-of-service office test for airway inflammation. The first half of this practice management review presents the methodological, interpretative, and clinical applications of FeNO. The second half discusses practical management issues, including current and future technology, equipment specifications, US Food and Drug Administration regulations, cost, current procedural terminology coding, and reimbursement. The measurement of FeNO is helpful in the diagnosis of asthma. It is predictive of a response to inhaled corticosteroids (ICSs). Monitoring FeNO is useful in maintaining asthma control by allowing the assessment of adherence to medication and dose titration of ICSs. An elevated level of FeNO is predictive of asthma relapse following corticosteroid withdrawal especially in children. The advances in technology, ease of use, and clinical utility will lead to greater availability, acceptance, and routine application in the care of asthma.

Asthma is characterized by reversible bronchos-pasm, bronchial hyperresponsiveness, and airway inflammation. Proper antiinflammatory treatment requires accurate assessment and monitoring of the underlying inflammatory state of the airways. Until recently, there has been no point-of-service test available to assess airway inflammation in asthma. The adequacy of antiinflammatory control is commonly assessed imperfectly by clinical inference (ie, resolution of symptoms and physical findings), improvement in airflow limitation, and bronchial hyperresponsiveness in response to therapy. It is important to recognize that these various clinical and physiologic outcomes do not track each other consistently Health and Care Pharmacy online. They are only partially related to airway inflammation and may be influenced by other interwoven pathophysiologic mechanisms. It is now possible to assess airway inflammation in asthma patients by measuring the fractional concentration of exhaled nitric oxide (FeNO) during an office visit.