Category: NObreath

Bedfont® Scientific Limited is pleased to support a major milestone to improve asthma care

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Intermedical UK proudly delivers the 3,000th NObreath® FeNO device to the UK market.

Bedfont® Scientific Limited, a medical device manufacturer based in Kent, with over 49 years’ experience in the breath analysis industry, was pleased to support its UK distributor, Intermedical UK, in supplying the 3,000th NObreath® Fractional exhaled Nitric Oxide (FeNO) device in the UK. Intermedical UK, a trusted leader in respiratory health, has been providing cardio-respiratory diagnostic and therapy equipment for frontline care since 1997.

Bedfont® support major milestone in asthma care. Bedfont Supports FeNO Milestone.
Bedfont® and Intermedical Team

Livio Gagliardi, Acting Managing Director at Intermedical (UK) Ltd, said, “Reaching the 3,000th NObreath® FeNO device in the UK is a shared success that reflects the dedication of both the Intermedical and Bedfont® teams. Together, we have worked hard to deliver a clinically proven, accessible, and cost-effective FeNO solution that genuinely meets the needs of frontline healthcare. We are incredibly grateful to our customers for placing their trust in us and for recognising the value that NObreath® brings to asthma diagnosis and ongoing management. Their commitment to improving respiratory care is what makes milestones like this possible, and we look forward to continuing this journey of innovation and impact alongside Bedfont®.”

NObreath FeNO device. Bedfont Supports FeNO Milestone.

The NObreath® FeNO device, manufactured by Bedfont®, is an innovative diagnostic tool that measures airway inflammation and helps healthcare professionals diagnose and manage asthma effectively. With over 3,000 devices now available across the UK, access to FeNO testing is improving, bringing Bedfont® closer to a world where everyone can access instant, non-invasive, and simple breath testing to support medical diagnosis.

As a valued long-term distributor of the NObreath®, Intermedical UK has played a key role in expanding access to high-quality respiratory diagnostics, and the close partnership over the years has been instrumental in reaching this monumental milestone.

Jason Smith, CEO at Bedfont®, comments, “This milestone of 3,000 devices in UK primary care highlights just how rapidly objective asthma testing is advancing. The updated joint UK guidelines now place even greater emphasis on FeNO, echoing the global shift toward evidence-based, accessible diagnostic tools. We are committed to making this technology available everywhere it is needed, ensuring clinicians and patients around the world benefit from fast, non-invasive breath testing.”

Bedfont® remains committed to improving asthma care worldwide, working closely with a global network of distributors to expand access to FeNO testing and improve asthma treatment. Recent partnerships in Mexico and India are already strengthening diagnostic capabilities, enabling clinicians in these regions to integrate simple, non-invasive breath testing into routine asthma assessment.

To learn more about Bedfont® and the NObreath® FeNO device, visit the website here.

Bedfont® Scientific Limited Expands Global Access to FeNO Testing in India

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Rbeck Healthtech Private completes registration for the NObreath® FeNO device, helping to improve asthma care across the region.

Bedfont® Scientific Limited, world leaders in breath analysis, with over 48 years of experience in designing and manufacturing medical breath analysis devices, has collaborated with Rbeck Healtech Private to make Fractional exhaled Nitric Oxide (FeNO) testing more accessible in India. Rbeck Healthtech Private is an entirely diverse healthcare equipment distributor, with a portfolio specialising in pulmonology, cardiology, and rehabilitation. It has recently added the innovative NObreath® device to its offerings, expanding access to FeNO testing in India.

Asthma is a chronic lung disease which cannot be cured; however, with the correct diagnosis and treatment, people with asthma can lead normal lives. India accounts for approximately 13.1% of the global asthma burden1, meaning that improving access to essential diagnostic and management tools, such as the NObreath®, is vital. The NObreath® measures FeNO levels on exhaled breath, a key indicator in type 2 airway inflammation, which is commonly found in asthma.

Jason Smith, CEO at Bedfont®, comments, “Partnering with Rbeck Healthtech and the successful registration for the NObreath® in India is a meaningful milestone in our mission to make precision asthma care accessible worldwide. India faces a significant burden of asthma, and we believe that FeNO testing can empower clinicians with clearer insights into airway inflammation, leading to more personalised and effective treatment decisions.”

With the Global Asthma Report 2022 indicating that a considerable proportion of asthmatic individuals remain underdiagnosed or untreated2 in India, it is hoped that this strategic partnership will help expand the accessibility of FeNO testing in the region, ultimately saving lives.

To find out more about the NObreath® and how it is improving asthma care worldwide, visit the website here.

References

1.Singh S, Salvi S, Mangal DK, Singh M, Awasthi S, Mahesh PA, et al. Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study. ERJ Open Research [Internet]. 2022 May 30;8(2):00528-2021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149387/

2.The Global Asthma Report 2022 [Internet]. Globalasthmareport.org. 2022 [cited 2025 Oct 8]. Available from: https://globalasthmareport.org/regions/india.php?

Practical insights for asthma care: The new NICE/BTS/SIGN guidelines. Why FeNO first?

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Part 2: Why FeNO first? Spotlight on testing & special cases

In Part 1, we explored the redefined approach to asthma diagnosis under the new NICE/BTS/SIGN guidelines. In Part 2, we dive deeper into the role of Fractional exhaled Nitric Oxide (FeNO) testing, looking at why it is now a frontline diagnostic tool and how it fits into broader asthma care, especially for children and those with occupational risks.

Why is FeNO now highlighted in the new guidelines?

FeNO has always been included in the guidelines and was central to the previous National Institute for Health and Care Excellence (NICE) guidelines for asthma care and management; however, the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) previously only recommended FeNO to prove an asthma diagnosis. Now, all three have come together and recommended a FeNO test as a first-line diagnostic test for asthma.

Nitric Oxide (NO) is a gas we breathe out all the time; it is a normal part of the respiratory process. When a person has eosinophilic inflammation, more NO is produced, which results in a higher FeNO reading.

Occupational asthma

There is no new update to the guidelines on occupational asthma; the guidelines refer you to the BTS clinical statement for occupational asthma. It does state that if a patient has adult-onset asthma or poorly controlled established asthma, you should check if the symptoms are work-related, by asking the following questions:

  • Are your symptoms the same, better or worse on days away from work?
  • Are your symptoms the same, better or worse when on holiday or longer than usual breaks from work?

If symptoms worsen at work and occupational asthma is suspected, the patient should be referred to a specialist.

Asthma diagnosis in children (Aged 5-16)

As with adults, once a clear history and physical examination has taken place and asthma is suspected, you can move on to carrying out tests.

The first and only recommended test for children is a FeNO test. This means that a FeNO device should be available in primary care.

  • If the FeNO result does not support an asthma diagnosis, you should move on to bronchodilator reversibility (BDR) with spirometry. However, children on the younger side of the age bracket may find this test very challenging.
  • If this is the case, the guidelines recommend you move on to a peak flow diary.
  • A skin prick test is recommended if the peak flow diary results do not suggest asthma. Unfortunately, skin prick testing is not widely available, so this may not be possible.
  • Blood eosinophils are recommended last due to the invasiveness of the test.

How can you incorporate FeNO testing?

In some Primary Care Networks (PCNs), nursing teams have short slots available daily to perform FeNO tests on the day of presentation. This means the entire nursing team is trained to perform and correctly code a FeNO test and result. This approach, however, is not always possible in some settings, so some will ensure all clinicians are appropriately trained. This means that patients can receive instant results, start treatment immediately in the same appointment, and be referred to the asthma specialist for a follow-up.

Children under 5 years old

Previously, healthcare professionals (HCPs) were told not to diagnose asthma in children under 5 years old; it was recommended that they wait until they were 5 years old to make a diagnosis.

The new guidelines recognise that diagnosing this age group is challenging, as young children do not have the breath control required to take a test.

The recommendations in the new NICE/BTS/SIGN guidelines are:

  • If you suspect asthma, use your clinical judgement to treat and review regularly.
  • Once the patient reaches 5 years old, attempt to test for asthma. However, it is unclear whether treatment should stop before the test.
  • If the test is unsuccessful, continue treatment with regular reviews.
  • Re-attempt the tests every 6-12 months.
  • If the patient is not responding to treatment, refer them to a specialist, as it may not be asthma.

The guideline also recommends that any preschool child admitted to the hospital or had two or more emergency care visits because of respiratory issues in 12 months be referred to a specialist.

What’s next?

With a clearer understanding of FeNO testing and its applications, we will now focus on how these new guidelines reshape asthma treatment and long-term management. In Part 3, we will cover therapy options across age groups, medication strategies, and key recommendations for improving asthma control.

To keep up to date with our upcoming webinars, please follow us on social media or visit our website here.

Practical insights for asthma care: The new NICE/BTS/SIGN guidelines. Why FeNO first?

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Part 1: Understanding the changes – Asthma diagnosis & first steps in the new guidelines

In light of the recent update to the National Institute of Care Excellence (NICE) guidelines for asthma care and management, Bedfont® Scientific Limited sponsored an informative webinar by Intermedical (UK) Limited. Seasoned respiratory nurse Carol Stonham MBE led the session, where she discussed the changes to the guidelines in detail and why Fractional exhaled Nitric Oxide (FeNO) testing is vital to the asthma pathway.

In this first part of our three-part series covering this insightful webinar, we focus on the foundations: patient-centred care, changes in diagnostic criteria, and the importance of the structured clinical assessment.

Carol Stonham MBE, has been a registered nurse since 1986, transitioning from acute hospital settings to primary care by 1990. She serves at the Gloucestershire ICB and leads the Respiratory Clinical Programme Group, as well as co-leading the NHSE South West Respiratory Network. Carol is also a member of the Bedfont® Medical Advisory Board.

Intermedical (UK) Limited are a leading specialist provider of medical diagnostic and therapy equipment in the UK’s cardio-respiratory healthcare sector. Trusted in respiratory health since 1997, they are the exclusive distributor of the Bedfont® NObreath® FeNO device in the UK.

Usually, guideline updates involve adjustments to recommendations here and there, but this update represents a seismic shift in how asthma is diagnosed and managed. This blog will examine what the guidelines tell us and where FeNO fits in.

The first recommendation, which healthcare professionals (HCPs) must be aware of and follow, is that healthcare should be patient-centred. Patients should be given enough time and information to make informed decisions about their care. Unfortunately, this can be tricky if the areas in which the HCPs work have a restrictive formulary.

How is asthma diagnosed?

Firstly, as a HCP, you should take a good and clear history to ensure asthma is suspected before you test for it. It is easy to see a cough or a wheeze, but this is not how a diagnosis should be made.

The recommendation has gone from HCP-reported wheeze to just “reported wheeze”. This is something to be cautious about, as the patient’s interpretation of a wheeze could be very different from what a HCP interprets as a wheeze.

  • Noisy breathing, cough, and chest tightness are the symptoms you could expect someone with asthma to have, but it is important to remember that they should vary. This means the symptoms are not the same every day; the variation could be the time of day or time of year, for example.
  • The patient should be able to identify triggers, such as “my symptoms are worse when I go from warm to cold”, etc.
  • You should ask about a family history of atopic disorders and be sure that the symptoms are not due to anything else. All other possibilities should be ruled out before you arrive at asthma.

Previously, the Quality and Outcomes Framework (QOF) said that more than one objective test is sufficient for an asthma diagnosis, and the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) said you could diagnose asthma with no supportive tests.

The new joint guideline from NICE/BTS/SIGN brings clarity and consistency to asthma diagnosis, stating that a diagnosis can be made with a suggestive clinical history and just one supportive objective test, making the process easier for HCPS to follow.

As mentioned in the previous guideline, when an asthma diagnosis is made, it must be recorded how you came to that diagnosis. This is an important step, as if further down the line the patient is not responding to treatment, the HCP can go back to the diagnosis and see how the diagnosis was made to be sure it was correct.

What to do with patients who are presenting?

Typically, two groups of people present in primary care: those who come in looking and feeling perfectly well but say they have been wheezy and tight-chested at times, but feel perfectly fine today. Then, some come in and are experiencing symptoms at the time, and when you delve into the history, you find that it has been going on for a little while and that something has tipped them into an exacerbation.

The guidelines say that patients must be treated if they are acutely unwell at presentation. It may be unsafe to send them away without treatment while you wait for tests. If possible, carry out a test there and then, and if the patient is not well enough to take a test or the tests aren’t available, then it is recommended that you start treatment immediately and carry out the tests when possible. However, it is recognised that by doing this, the test results could return to normal due to the treatment.

The guideline recommends the following tests for asthma diagnosis:

  • Blood eosinophils,
  • FeNO test,
  • Spirometry,
  • Peak flow with bronchodilator reversibility (BDR).

Ideally, you want to do the test there and then and choose the quickest and easiest option for the patient. Usually, tests such as spirometry and peak flow aren’t easy to do when the patient is unwell; therefore, a FeNO test would be the ideal option.

Patient examination

When examining a patient, you should look for the classic expiratory polyphonic wheeze. This is specifically seen in patients with asthma when they breathe out. However, patients presenting well that have reported being unwell may not have this wheeze, which should not rule out an asthma diagnosis, so testing should be conducted.

Test sequence

Once a clear history and a physical examination has taken place and asthma is suspected, you can move on to carrying out tests.

The first-line test for adults and young people over 16 is blood eosinophils or FeNO. While blood eosinophils may be considered appropriate for adults, a follow-up appointment to discuss the results would be required. It is possible to look up previous blood test results, but people, especially young people, do not often have regular blood tests, so this information may not be available. Unfortunately, primary care is usually short on time, so the quickest test option would be a FeNO test, if available. The test is quick and easy, non-invasive, and can be carried out within the same appointment.

  • If the blood eosinophils or FeNO result suggests asthma, you do not need to proceed any further with testing, as an asthma diagnosis can be made.
  • If these results do not suggest asthma, you should move on to BDR with spirometry. The guidelines recognise that spirometry isn’t as widely available as it should be, so if there is a delay in access to this test, you can move on to a peak flow diary.
  • If these further tests do not suggest asthma, you can move on to the bronchial challenge. However, this is a last resort test, not a test that should be carried out in primary care. A bronchial challenge test is high risk, and you should ensure easy access to resuscitation facilities.

We will look at the test sequence for children aged 5-16 in part 2.

What’s next?

Now that the groundwork for asthma diagnosis under the new guidelines has been laid out, it is time to look at the tools transforming how we confirm the diagnosis. In Part 2, we will explore why FeNO testing is taking centre stage and how it fits into asthma care across all age groups.

To keep up to date with our upcoming webinars, please follow us on social media or visit our website here.

Bedfont® Scientific Limited and Aerosol Medical Systems partner, expanding access to FeNO testing in Latin America

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The NObreath® device enhances access to FeNO diagnostics in Mexico.

Bedfont® Scientific Limited, a world leader in breath analysis with nearly 50 years of expertise in the medical breath analysis industry, has formed a strategic partnership with Aerosol Medical Systems to improve Fractional exhaled Nitric Oxide (FeNO) testing accessibility in Latin America. Aerosol Medical Systems is an established leader in the field of respiratory therapy, providing a comprehensive service to improve quality of life.

“We are committed to diagnosing and treating respiratory diseases and have completed, in collaboration with Bedfont®, the registration of the NObreath® device with the healthcare authorities in Mexico.” Comments Rodrigo León Molina, Director General and CEO at Aerosol Medical Systems. “The registration provides healthcare professionals with more accurate diagnostic tools and offers better treatment options for patients with asthma. This represents significant growth in the Mexican market, and will allow a larger number of tests to identify asthma early and better control the disease.”

In 2019, a report found that in Mexico, 1,655 people died from asthma1, highlighting the need for better asthma care across the region. The successful registration for the NObreath® FeNO device in Mexico is a vital step to improving the accessibility of innovative diagnostic and management tools for asthma care.

“Our mission has always been to provide cutting-edge medical devices at affordable prices to improve accessibility and healthcare standards worldwide.” Said Jason Smith, CEO at Bedfont®. “By collaborating with Aerosol Medical Systems, we’re helping clinicians across Mexico deliver faster, more personalised asthma care, empowering patients to live healthier lives.”

Working on a foundation of shared values, including providing exceptional service, this partnership aims to improve asthma care in Mexico by ensuring that those living with this respiratory condition have access to instant, non-invasive, and simple breath testing to aid diagnosis and management.

To learn more about the NObreath®, visit the website here.

References

1.Lopez-Bago A, Lascurain R, Hernandez-Carreño PE, Gallardo-Vera F, Argueta-Donohue J, Jimenez-Trejo F, et al. Sex, Age, and Regional Disparities in the Burden of Asthma in Mexico from 1990 to 2019: A Secondary Analysis of the Global Burden of Disease Study 2019. Sustainability [Internet]. 2023 Aug 20 [cited 2025 Oct 14];15(16):12599–9. Available from: https://www.mdpi.com/2071-1050/15/16/12599?

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Winter is coming: preparing asthma patients with FeNO monitoring

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Research has shown that seven out of ten people with asthma report that cold air exacerbates their asthma symptoms1. As winter approaches quickly, it is essential to prepare for asthma management in advance. A vital tool in asthma management, as recommended by the National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN), is Fractional exhaled Nitric Oxide (FeNO) testing2. In this blog, we will explore how FeNO testing can play a crucial role in asthma management this winter.

Winter challenges for asthma patients

During the winter months, the air temperature drops, and this can impact people living with asthma for various reasons:

  • Cold air causes the airways to narrow1.
  • Cold, dry air can irritate the airways, exacerbating symptoms1.
  • Cold air can weaken the immune system, making it easier to catch respiratory infections1.
  • Spending more time indoors during winter makes the spread of respiratory infections easier1.

Asthma + Lung UK found that hospital admissions for lung diseases, such as asthma, rose by 80% in December, January, and February, compared to Spring3. These figures highlight the significant impact that respiratory conditions, such as asthma, have on healthcare systems during the winter months. FeNO testing is a vital tool in improving the quality of life for asthma patients during the winter months.

What is FeNO testing?

FeNO is a biomarker for eosinophilic airway inflammation, a condition commonly associated with asthma. When a person’s airways are inflamed, more Nitric Oxide (NO) is produced, and this can be measured in exhaled breath in parts per billion (ppb). Taking a FeNO test with a FeNO device like the NObreath® is a quick, easy, and non-invasive process. During the test, the patient takes a deep breath and then exhales into the NObreath®. An instant FeNO reading is displayed, allowing you to determine a person’s level of airway inflammation in as little as five minutes4.

FeNO testing with the NObreath®

The NObreath® is an innovative FeNO device, specifically designed for use in primary and secondary care settings. Fully portable, the NObreath® can be easily carried between consulting rooms, providing a quick and convenient solution for FeNO testing in busy settings. The device has an adult and child test mode, making it perfect for all ages.

Why is FeNO testing crucial before and during winter?

Providing a FeNO test at regular asthma reviews allows clinicians to proactively monitor a patient’s airway inflammation, allowing them to identify rising inflammation before symptoms spike. It also helps to provide personalised treatment plans and guide inhaled corticosteroid (ICS) titration, ultimately reducing exacerbations and unnecessary hospital visits.

The latest joint UK guidelines from NICE, BTS, and SIGN recommend FeNO as a first-line test for asthma diagnosis and a vital tool for asthma management2, making it clear that FeNO testing should be available throughout the country. With this in mind, regular asthma reviews are essential throughout the year, not just during the winter months. FeNO testing is the perfect way to establish a person’s airway inflammation, allowing healthcare professionals to personalise treatment plans and therefore improving quality of life for those with asthma.

For more information on FeNO testing with the NObreath®, visit the website here.

References

  1. Asthma and Lung UK. Cold Weather and Your Lungs | Asthma + Lung UK [Internet]. www.asthmaandlung.org.uk. 2023. Available from: https://www.asthmaandlung.org.uk/living-with/cold-weather
  2. ‌NICE. Overview | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE [Internet]. Nice.org.uk. NICE; 2024. Available from: https://www.nice.org.uk/guidance/NG245
  3. ‌Out in the cold: lung disease, the hidden driver of NHS winter pressure | Asthma + Lung UK [Internet]. www.asthmaandlung.org.uk. Available from: https://www.asthmaandlung.org.uk/out-cold-lung-disease-hidden-driver-nhs-winter-pressure
  4. Fractional Exhaled Nitric Oxide (FeNO) Test | North Bristol NHS Trust [Internet]. Nbt.nhs.uk. 2024 [cited 2025 Jun 23]. Available from: https://www.nbt.nhs.uk/our-services/a-z-services/respiratory-medicine/respiratory-patient-information/fractional-exhaled-nitric-oxide-feno-test

Back to School: Managing Childhood Asthma

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September sees the return to school for children after the summer holidays. While the return to routine is welcomed, it can be challenging for children with asthma. Research by Asthma + Lung UK found that in 2022/2023, there was a 348% rise in hospital admissions in 5-14-year-olds with an asthma attack in September compared to the previous month1. This staggering rise highlights the importance of helping parents or guardians manage their child’s asthma effectively as the school year begins.

Understanding the September asthma epidemic1

Many factors can contribute to the increase in asthma flare-ups when children return to school, including:

  • Interrupted medication routines throughout the summer holidays,
  • Exposure to triggers on the return to school,
  • Emotional stress experienced when starting a new school or school year.

With this in mind, parents or guardians must be well educated and prepared for the return to school.

How can parents or guardians prepare?

Various steps can be taken to ensure the return to school runs smoothly with minimal impact on a child’s asthma symptoms.

Arrange a pre-school check-up

Asthma reviews are essential for well-controlled asthma. Arranging a pre-school check-up provides a good opportunity to:

  • Assess how well your child’s asthma is controlled,
  • Review medication,
  • Check inhaler technique.

During the review, consider asking about Fractional exhaled Nitric Oxide (FeNO) testing. FeNO is a non-invasive test that measures airway inflammation in the lungs, which is often found in asthma. It can help confirm an asthma diagnosis if there is uncertainty, determine how well inhaled corticosteroids work, and guide adjustments in treatment2.

A FeNO test can be helpful if your child’s symptoms are inconsistent or you are unsure whether their asthma is fully under control heading into the school year.

FeNO testing with the NObreath® FeNO device

The NObreath® is a portable, non-invasive FeNO testing device designed to aid in asthma diagnosis and management. Carrying out a FeNO test with the NObreath® is quick and easy, making it the perfect choice for asthma care and management in children. The latest joint guidelines from the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN) recommend a FeNO test as the first-line test for asthma diagnosis in children3.

Understand your child’s asthma triggers

Triggers differ from person to person; one thing that might set symptoms off in one person may not cause symptoms in another, so it is essential to understand what triggers your child’s asthma. Common school-related triggers could include4:

  • Dust,
  • Pollen,
  • Cold air,
  • Physical activity,
  • Stress,
  • Classroom pets.

If you know your child’s triggers, it would be a good idea to communicate with the school staff to ensure they are aware, so triggers can be avoided if possible.

Communicate with the school

We briefly touched on communication with the school regarding triggers. However, it is important that the staff are aware of your child’s asthma, triggers and medication. When preparing your child’s medication and supplies, it is a good idea to label everything correctly and ensure the school is aware so inhalers can be stored safely at school. You should also ask about the school’s medication use and self-administration policy.

Teach self-management skills

Education is key, so the more your child knows about asthma and treatment, the better. They must know how to recognise their symptoms and how to use their inhaler correctly. Providing the correct age-appropriate education empowers your child to recognise worsening symptoms and when to ask for help.

Going back to school can be challenging for children and parents or guardians. However, asthma doesn’t need to impact this transition. The back-to-school process should run smoothly with the correct education, treatment, and preparation. We should also recognise that while starting a new school year can cause an exacerbation in asthma symptoms, it is important to remain vigilant throughout the year, ensuring your child’s asthma is well-controlled.

For more information on FeNO testing with NObreath® and its integral role in the asthma pathway, visit the website here.

References

  1. Number of children in hospital with life-threatening asthma attacks could quadruple as they return to school [Internet]. Asthma + Lung UK. 2024. Available from: https://www.asthmaandlung.org.uk/media/press-releases/number-children-hospital-life-threatening-asthma-attacks-could-quadruple-they
  2. NHS England. NHS Accelerated Access Collaborative» Fractional Exhaled Nitric Oxide (FeNO) [Internet]. www.england.nhs.uk. Available from: https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/rapid-uptake-products/fractional-exhaled-nitric-oxide/
  3. NICE. Overview | Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) | Guidance | NICE [Internet]. Nice.org.uk. NICE; 2024. Available from: https://www.nice.org.uk/guidance/NG245
  4. Asthma at school and nursery | Asthma + Lung UK [Internet]. www.asthmaandlung.org.uk. 2024. Available from: https://www.asthmaandlung.org.uk/conditions/asthma/child/life/school

Clinical guidelines on FeNO

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Fractional exhaled Nitric Oxide (FeNO) is extensively utilised in both primary and secondary care settings worldwide. Many regions recommend FeNO-guided management as part of their clinical protocols. This article reviews FeNO-related guidelines in the UK and internationally, with a focus on comparing approaches across different regions.

Guidelines

NICE, BTS, and SIGN guidelines1:

The latest and most significant updates to UK guidelines were in November 2024, when the National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) updated and published a joint guideline on asthma diagnosis, monitoring, and chronic asthma management. Before this, NICE, BTS, and SIGN published their guidelines independently, the newly published guidelines bring harmonisation across the board. This review brings significant changes to asthma care approaches, including applying FeNO testing- an objective airway inflammation test for aiding in asthma diagnosis and management.

The guideline can be read here.

ERS guidelines2:

In 2022, the European Respiratory Society (ERS) updated its guidelines for the diagnosis of asthma in adults. In patients suspected of asthma, in whom the diagnosis is not established based on the initial spirometry combined with bronchodilator reversibility testing, ERS suggest measuring FeNO as part of the diagnostic work-up of adults aged > 18 years old with suspected asthma (conditional recommendation for the intervention, moderate quality of evidence).

The guideline can be read here.

DGP guidelines3:

The German Respiratory Society (The Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, DGP) is the largest and oldest medical professional organisation for respiratory disorders. The latest guidelines on asthma, published in 2023, titled ‘S2K guidelines for specialist diagnosis and therapy of asthma’. FeNO is described as an indispensable component of specialist asthma diagnostics.

The guideline can be read here.

ATS guidelines4,5:

In 2011, the American Thoracic Society (ATS) developed guidance on the interpretation of FeNO testing in adults and children (up to 12 years old). The latest update to the American Thoracic Society (ATS) regarding FeNO to guide the treatment of asthma was in 2021. The update includes FeNO testing being strongly recommended to manage asthma in patients, in addition to usual care.

The American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Allergy, Asthma and Immunology (AAAAI), published a joint statement in 2012 in response to the ATS guidelines “The American College of Allergy, Asthma and Immunology and the American Academy of Allergy, Asthma and Immunology formally recognize and support the 2011 ATS Clinical Practice Guideline on the Interpretation of Exhaled Nitric Oxide for Clinical Applications.”6.

 The guideline can be read here and here.

GINA guidelines7,8:

The Global Initiative for Asthma (GINA) works with healthcare professionals, patient representatives, and public health officials around the world to reduce asthma prevalence, morbidity, and mortality. GINA’s guidelines, which were updated in 2024, recognise FeNO as a useful biomarker for aiding in asthma diagnosis and management. The guideline provides ppb recommendations for diagnosis; however, for children, GINA does not specify exact cutoffs but acknowledges its role in guiding treatment.

The guideline can be read here and here.

Reimbursement for FeNO:

Each country has different policies regarding reimbursement for FeNO testing. In England, practices strive to accomplish maximal Quality and Outcomes Framework (QoF)9 points to maintain practice income and fund expenses such as the purchase and maintenance of equipment, for example, FeNO devices. Currently, the QoF requirement for diagnosis of asthma is spirometry and one other test, such as FeNO, bronchodilator reversibility or measures of variability. With the change in the BTS/SIGN/NICE guideline, this will change in line with the guideline recommendations, with the requirement that practices perform at least one objective test that indicates asthma. In adults initially, this could be FeNO or blood eosinophils; in children, the initial test must be FeNO.

Across Europe, reimbursement policies vary widely, depending on national health guidelines. In Germany, FeNO testing is endorsed in the national asthma guidelines; however, FeNO is not reimbursed by Statutory Health Insurance (SHI) in primary care settings. In North America, Medicare and Medicare Advantage plans provide reimbursement for FeNO testing if the test is deemed medically necessary by your healthcare professional10.

Why guidelines matter:

The use of asthma diagnosis and management guidelines in the application of FeNO is essential globally, to ensure standardised, evidence-based asthma management, tailored to varying healthcare infrastructures and patient demographics. These guidelines empower healthcare professionals to make informed decisions, enhancing the accuracy of asthma diagnosis and treatment. Established guidelines fosters consistency in care, contributing to sustainable healthcare costs, reducing misdiagnosis, and ultimately improving patient outcomes. It’s worth noting that besides the countries listed in this article, numerous others also have national guidelines, including Japan, Italy, China, France, Mexico, Spain, Malaysia, Australia, and many more!

Key Takeaways

NICE, BTS, SIGN guidelines1:

Diagnosis:

  • For adults, asthma can be diagnosed if FeNO levels are ≥ 50 ppb or higher, an increase from the previous NICE guideline’s 40 ppb or higher threshold.
  • For children, asthma can be diagnosed if FeNO levels are ≥ 35 ppb or higher. This has remained the same as the previous NICE guidelines.
  • FeNO testing is recommended as first-line testing in asthma diagnosis for adults and children.
  • If the first test is diagnostic, further diagnostic testing is not required.

Management:

  • FeNO testing has been acknowledged as a tool in asthma management.
  • It aids to inform healthcare professionals when changing or adjusting asthma therapy.
  • Recommend FeNO use for asthma monitoring in adults.

ERS guidelines2:

Diagnosis:

  • A cut-off of 40 ppb offers the best compromise between sensitivity and specificity while a cut-off of 50 ppb has a high specificity of > 90% and is therefore supportive of asthma diagnosis.
  • A FeNO value < 40 ppb does not rule out asthma, and similarly, high FeNO levels themselves do not define asthma.

Management:

  • Measure FeNO as part of the diagnostic work-up of adults aged 18 years with suspected asthma (conditional recommendation for the test, moderate quality of evidence).

DGP guidelines3:

Diagnosis:

  • Low FeNO levels < 25 ppb (< 20 ppb in children) can be used to indicate that eosinophilic inflammation and responsiveness to corticosteroids are less likely.
  • High FeNO levels > 50 ppb (> 35 ppb in children) can be used to indicate that eosinophilic inflammation and, in symptomatic patients, responsiveness to corticosteroids are likely.

Management:

  • Patients with elevated FeNO levels are usually ICS-responsive. Elevated FeNO levels (especially FeNO levels > 50 ppb) during ICS therapy, despite clinical stability, argue against reducing the ICS dose.
  • In children and adolescents, regularly monitored FeNO proved to be a meaningful parameter to predict asthma relapse after planned ICS discontinuation, even before the onset of clinical symptoms.

ATS guidelines4,5:

Diagnosis:

  • Low FeNO levels < 25 ppb (< 20 ppb in children) can be used to indicate that eosinophilic inflammation and responsiveness to corticosteroids are less likely.
  • Intermediate FeNO values between 25 ppb and 50 ppb (20 ppb and 35 ppb in children) should be interpreted cautiously and with reference to the clinical context.
  • High FeNO levels > 50 ppb (> 35 ppb in children) can be used to indicate that eosinophilic inflammation and, in symptomatic patients, responsiveness to corticosteroids are likely.

Management:

  • FeNO is beneficial and should be used in addition to usual care.
  • Recommend the use of FeNO in monitoring airway inflammation in patients with asthma.

GINA guidelines7,8:

Diagnosis:

  • High FeNO levels > 50 ppb in non-smokers are moderately associated with eosinophilic airway inflammation.
  • FeNO levels above ≥ 20 ppb in adults with who have difficult-to-treat or severe asthma support the presence of type 2 airway inflammation.

Management:

  • Measure FeNO as an adjunct to diagnostic evaluation in individuals with suspected asthma and to monitor airway inflammation.

FeNO testing with the NObreath®:

Regular FeNO measurements indicate levels of airway inflammation, which can help healthcare professionals personalise treatment plans for patients by helping titrate ICS dosing and evaluate patient adherence to treatment.

For over 48 years, Bedfont® Scientific Limited has specialised in designing and manufacturing breath analysis medical devices. Using innovative technology, we provide cutting-edge medical devices at affordable prices to improve accessibility and healthcare standards worldwide. Bedfont® manufactures the NObreath® FeNO device, a non-invasive breath testing device which can be used to measure airway inflammation for the diagnosis and management of asthma.

For more information on the NObreath® and FeNO testing, visit the NObreath® website.

References:

  1. Asthma pathway (BTS, NICE, SIGN) [Internet]. National Institute for Health and Care Excellence. 2024. [Cited Friday 17th January 2025]. Available from: https://www.nice.org.uk/guidance/ng244
  2. Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, Rigau D, Ten Brinke A, Buhl R, Loukides S, Kocks JW. European Respiratory Society guidelines for the diagnosis of asthma in adults. European Respiratory Journal. 2022 Sep 1;60(3). DOI: 10.1183/13993003.01585-202.
  3. Lommatzsch M, Criée CP, de Jong CC, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M. Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023-published by the German Respiratory Society (DGP) e. V. Pneumologie (Stuttgart, Germany). 2023 Jul 5. DOI: 10.1055/a-2070-2135.
  4. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR, American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. American journal of respiratory and critical care medicine. 2011 Sep 1;184(5):602-15. PMCID: PMC4408724 PMID: 21885636.
  5. Khatri SB, Iaccarino JM, Barochia A, Soghier I, Akuthota P, Brady A, Covar RA, Debley JS, Diamant Z, Fitzpatrick AM, Kaminsky DA. Use of fractional exhaled nitric oxide to guide the treatment of asthma: an official American Thoracic Society clinical practice guideline. American journal of respiratory and critical care medicine. 2021 Nov 15;204(10):e97-109. PMCID: PMC8759314 PMID: 34779751.
  6. Zitt M, Oppenheimer J, Bernstein D, Boggs P, Dinakar C, Jain N, Katial N, Sands M, Szefler S. AAAAI/ACAAI joint statement of support of the ATS clinical practice guideline: interpretation of exhaled nitric oxide for clinical applications. 2012 [Internet]. 2014.
  7. Global strategy for asthma management and prevention [Internet]. Global Initiative for Asthma. 2024. [Cited Friday 17th January 2025]. Available from: https://ginasthma.org/2024-report/
  8. Murugesan N, Saxena D, Dileep A, Adrish M, Hanania NA. Update on the role of FeNO in asthma management. Diagnostics. 2023 Apr 15;13(8):1428. DOI: 10.3390/diagnostics13081428.
  9. NHS England [Internet]. Quality and outcomes framework guidance for 24/25. 2024. [Cited 22nd April 2025]. Available from https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2024-25/
  10. Healthline [Internet]. What you need to know abut FeNO testing for asthma. 2024. [Cited 22nd April 2025]. Available from: https://www.healthline.com/health/asthma/feno-test-asthma?c=1285499318383#takeaway

Bedfont® Scientific Limited Brings Cutting-Edge Respiratory and Gastrointestinal Diagnostic Solutions to Saudi Arabia with New Registration`

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NObreath® FeNO device and Gastrolyzer® range of devices are now available across the Middle East.

Bedfont® Scientific Limited, a world leader in breath analysis with over 47 years of knowledge and expertise in designing and manufacturing medical breath analysis devices, has partnered with Tebaba Medical Services, a leading supplier of high-quality medical supplies for healthcare providers across Africa and the Middle East. The successful registration in October means Tebaba will distribute Bedfont’s cutting-edge technology to healthcare professionals in the region, aiding in diagnosing and managing respiratory and gastrointestinal conditions.

The NObreath® Fractional exhaled Nitric Oxide (FeNO) device is used to aid in the diagnosis and management of asthma by measuring the nitric oxide levels on exhaled breath. High levels of nitric oxide indicate airway inflammation, common in allergic asthma.

The Gastrolyzer® range of devices, comprising of the Gastro+™ which measures the amount of hydrogen and the GastroCH4ECK® which measures the amount of hydrogen and methane in the breath, which can indicate gastrointestinal (GI) disorders such as small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption.

Tebaba Medical Services, a well-established leader in the Middle Eastern healthcare market, was selected as a distributor for its strong alignment with Bedfont’s core values. With a commitment to delivering high-quality medical devices and exceptional customer service, Tebaba Medical Services brings extensive regional expertise to this partnership. By working together, Bedfont® and Tebaba are advancing the availability of cutting-edge breath analysis technology across the Middle East.

Jason Smith, CEO at Bedfont®, comments, “We are excited about the registration, which will allow our cutting-edge technology to transform the impact on respiratory and gastrointestinal health across the Middle East, marking an important step in our vision where everyone has access to instant, non-invasive, simple breath testing to aid in medical diagnosis.”

The first shipment was delivered in November, marking the beginning of Bedfont’s long-term commitment to supporting healthcare providers in the region with reliable, innovative technology and paving the way for enhanced patient care.

For more information on Bedfont® breath analysis devices, please visit our website by clicking here.

New NICE Guidelines for Asthma: FeNO Testing and the NObreath® Device in Adult and Paediatric Care

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On Wednesday, 27th November, the National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) updated and published a joint guideline on asthma diagnosis, monitoring, and chronic asthma management. 

Streamlining asthma management

BTS/SIGN and NICE published guidelines independent of each other. To align approaches to asthma care throughout the UK, NICE has undertaken a joint review with BTS and SIGN to bring harmonisation across the board. This review brings significant changes to asthma care approaches, including applying fractional exhaled nitric oxide (FeNO) testing- an objective airway inflammation test for aiding in asthma diagnosis and management.

Previously, NICE, BTS and SIGN recommended the following:NICE:

  • FeNO testing was recommended for use in adults and children during asthma diagnosis.
  • FeNO levels, should be measured in conjunction with other diagnostic tests (e.g., spirometry).
  • For adults: A FeNO level of 40 parts per billion (ppb) or more was regarded as a positive test.
  • For children and young people (5–16 years): A FeNO level of 35 ppb or more was regarded as a positive test.

BTS and SIGN:

  • FeNO testing can support asthma diagnosis, particularly when the diagnosis is uncertain or symptoms suggest eosinophilic inflammation in adults and children.
  • FeNO levels, should be measured in conjunction with other diagnostic tests (e.g., spirometry).
  • For adults: A FeNO level of 40 ppb or more was regarded as a positive test.
  • For children and young people (5–16 years): A FeNO level of 35 ppb or more was regarded as a positive test.

What is new? NICE/BTS/SIGN guideline on asthma: diagnosis, monitoring and chronic asthma management

Asthma diagnosis (adults):

The new NICE/BTS/SIGN guidelines recommend that adults with symptoms and a history suggestive of asthma undergo blood eosinophil count or FeNO testing as initial diagnostic steps. Asthma can be diagnosed if the blood eosinophil count exceeds the laboratory reference range or if FeNO levels are 50 ppb or higher. If these initial tests are inconclusive, bronchodilator reversibility (BDR) testing with spirometry is advised. When asthma remains clinically suspected despite inconclusive results from blood eosinophil count or FeNO, BDR, or peak expiratory flow (PEF) measurements, a referral for a bronchial challenge test is recommended to confirm the diagnosis if bronchial hyper-responsiveness is detected.

Asthma diagnosis (children and young people aged 5-16):

For children with symptoms suggestive of asthma, the new NICE/BTS/SIGN guidelines recommend measuring FeNO levels as a first-line diagnostic test, provided it is available. Asthma can be diagnosed if FeNO levels are 35 ppb or higher. A NICE literature review highlighted the higher specificity of FeNO testing in children, further reinforcing its use as a first-line option for both children and adults.

Asthma management (adults):

FeNO testing provides a significant advantage to health care professionals when monitoring asthma patients, including assessment of response to newly prescribed asthma therapies and regular review of adherence to medications. FeNO monitoring applications have been acknowledged globally in other well-recognised clinical guidelines, including the American Thoracic Society (ATS) and the Global Initiative for Asthma (GINA). Not acknowledged in previous asthma clinical guidelines by NICE or BTS/SIGN, a recommendation has been made to include FeNO evaluations as part of regular yearly asthma reviews in adults, alongside reviewing before and after any changes to patients’ asthma therapy.

Economic Evaluation of asthma care

Cost of exacerbations to the NHS:

NICE calculated that on average a mild to moderate exacerbation cost the NHS on average £42 per patient. This includes a GP visit (£38) and a salbutamol metered-dose inhaler (MDI) with a spacer (£4).

For severe exacerbations, the average estimated cost was thought to increase to £102 per patient. This includes 80% of patients requiring systemic glucocorticoid steroids (adults £1.88 and children £0.60), 13% of patients visiting A&E (£113), and 7% of patients needing hospitalisation (adults £1,181 and children £1,223).

FeNO cost analysis:

NICE conducted an economic evaluation of FeNO testing, factoring in the volume of tests performed on average across the UK. On average, taking into account the resource allocation of staff time and the cost of a FeNO test, an average total cost to the NHS would be £22.21 per patient. Among the eight diagnostic tests evaluated during NICE’s review, FeNO ranked as the third most cost-effective after adult blood eosinophil count and children’s blood eosinophil count.

NICE also highlighted the potential economic advantage of performing multiple tests during the same appointment, which could save time and reduce overall costs. The most cost-effective combination was spirometry and FeNO with a total cost of £34.29, followed by BDR and FeNO (£50.52) and skin prick test and FeNO, which ranked fourth most cost-effective (£50.66). These findings suggest strategic test combinations could optimise economic and clinical outcomes.

Carol Stonham, a member of Bedfont® Scientific Limited Medical Advisory Board and policy lead for Policy Care Respiratory Society (PCRS), comments “The new NICE/BTS/SIGN asthma guidelines introduce a positive step change in the diagnosis and management of asthma for adults and children. For diagnosis the necessity to perform numerous diagnostic tests has been reduced if initial testing confirms asthma, based on the evidence and cost effectiveness. In management the step away from using short acting bronchodilators to anti-inflammatory (AIR) and Maintenance and Reliever Therapy (MART) regimes should see better asthma control, less people with symptoms, and a reduction in asthma mortality.”

FeNO testing in asthma: Key takeaways from NICE guidelines

Diagnosis:

  • For adults, asthma can be diagnosed if FeNO levels are 50 ppb or higher, an increase from the previous NICE guideline’s 40 ppb or higher threshold.
  • For children, asthma can be diagnosed if FeNO levels are 35 ppb or higher. This has remained the same as the previous NICE guidelines.
  • FeNO testing recommended first-line testing in asthma diagnosis for adults and children.
  • If the first test is diagnostic further diagnostic testing is not required.

Management:

  • FeNO testing has been acknowledged as a tool in asthma management.
  • Aids to inform healthcare professionals when changing or adjusting asthma therapy.
  • Recommending FeNO use for asthma monitoring in adults.

Costs:

NICE’s economic evaluation revealed the average FeNO test to be on average £22.21, this includes an average consumable cost of £6.37. The NObreath® device, manufactured by Bedfont® Scientific Limited prides itself on being one of the most cost-effective products on the market. On average, NObreath® consumables (£3.70 per mouthpiece) are 42%* less than the FeNO testing consumables pricing highlighted in the NICE economic evaluation (£6.37), making the overall cost for FeNO testing 12%* less than what has originally been highlighted in the NICE economic evaluation, ensuring fair and accessible pricing for both primary and secondary care alike.  

To read the full NICE guidelines, please visit: https://www.nice.org.uk/guidance/ng244

*Based on UK pricing.

References:

  • Asthma pathway (BTS, NICE, SIGN) [Internet]. National Institute for Health and Care Excellence. 2024. [Cited Wednesday 27th November 2024]. Available from: https://www.nice.org.uk/guidance/ng244
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