Bedfont® Scientific Limited to showcase why the NObreath® is the FeNO device of choice at this year’s global event.
World leaders in breath analysis Bedfont® Scientific Ltd. are pleased to be attending this years American Thoracic Society (ATS) International Conference, to exhibit the innovative NObreath® Fractional exhaled Nitric Oxide (FeNO) device at booth 1236 alongside its US distributor coVita™. Bedfont® is an innovative MedTech company with nearly 50 years of expertise in the design and manufacture of medical breath analysis devices, helping to improve patient outcomes worldwide.
The ATS International Conference, taking place from the 15th and 20th May at the Orange County Convention Centre in Orlando, Florida, is a global event attracting more than 15,000 experts in pulmonary, critical care and sleep medicine to share groundbreaking research and advance clinical practice. Bedfont® will be sharing how the NObreath® is revolutionising asthma care worldwide.
The team can be found at booth 1236, where they will showcase the NObreath®, which has been helping to improve asthma care and management for over 15 years by providing objective insight into airway inflammation, a key feature of asthma. It enables clinicians to measure inflammation non-invasively, supporting a future where today’s science meets tomorrow’s care.
“We’re excited to be part of ATS this year and to bring our expert team together on the stand to engage with the global respiratory community. We invite attendees to come and speak with us, experience our technology firsthand, and explore how we can work together.” Said Jason Smith, CEO at Bedfont®. “ATS provides an important platform for us to showcase the NObreath® and its impact in respiratory care.”
Joining Bedfont® and coVita™ at booth 1236 is Medical Advisory Board Member, Carol Stonham MBE, a respiratory expert who serves as the Children and Young People Asthma Clinical Lead at Gloucestershire ICB. Carol will be bringing a wealth of knowledge to the event and will be hosting a talk at Innovation Hub 3 on Sunday 17th May at 1:15 pm EDT; where she will explore the role of FeNO in practice and discuss emerging opportunities.
You will find the Bedfont® team at booth 1236 between the 17th and 19th May, to find out more visit the website here.
In 2019, 262 million people worldwide had asthma, with 455,000 deaths from the chronic condition1, stark figures that highlight asthma control still needs improvement. Most people living with asthma believe that no physical symptoms mean their asthma is controlled, but this is sadly not always the case. Airway inflammation is the underlying cause of asthma, something that cannot be seen and not always felt.
Many asthma patients feel fine until they don’t. Objectively measuring airway inflammation with Fractional exhaled Nitric Oxide (FeNO) testing is a vital way to prevent exacerbations and improve overall asthma care.
What is FeNO and why does it matter2?
When airways are inflamed, they produce excess nitric oxide (NO), a gas that can be measured by performing a FeNO test. A FeNO test provides insight into a person’s airway inflammation by measuring NO levels in exhaled breath.
High FeNO levels indicate eosinophilic airway inflammation. The higher the reading, the more severe the inflammation is.
By measuring airway inflammation, healthcare professionals can use the results to aid an asthma diagnosis and tailor treatment appropriately.
Limitations of traditional asthma monitoring.
Traditionally, clinicians have relied on patients relaying their symptoms, which doesn’t always give the full picture of a person’s asthma. Many people believe that because they have asthma, they should have a cough and they should have a wheeze, and they downplay their symptoms.
Providing a FeNO test at regular asthma reviews empowers healthcare professionals to detect airway inflammation early, allowing them to monitor medication response and personalise treatment. This ultimately can catch an exacerbation early and get patients back on track with well-controlled asthma.
Additionally, medication adherence rates range from 30% to 70%3. A patient may report taking their medication regularly and using the correct technique; however, a quick, easy FeNO test can reveal poor adherence. Showing a patient their airway inflammation can create an opportunity to discuss and reinforce the importance of good adherence and technique.
Recent advancements in FeNO testing.
In the 1990s, researchers found that FeNO served as a non-invasive biomarker of airway inflammation and used chemiluminescence to measure it. This method proved very costly due to regular maintenance and calibration, and difficult to access because of the machines’ size and the specialist training required.
In recent years, this has advanced to electrochemical sensor technology, enabling more cost-effective, portable FeNO devices like the NObreath®, whilst still matching the gold-standard technology of chemiluminescence. Thanks to continuous innovation, FeNO devices are now accessible at the point of care and provide instant results, improving patient outcomes.
To learn more about chemiluminescence and electrochemical sensor technology, read our article here.
In the late 1990s, FeNO began to appear in international clinical practice guidelines for asthma, and the American Thoracic Society (ATS) officially recommended its use to assess airway inflammation in adults and children in 20114.
Since then, FeNO testing has been recommended in asthma guidelines across the world, with the most recent joint guidance from the National Institute for Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN), recommending FeNO as a first-line test for asthma diagnosis5.
To learn more about the global guidelines on asthma care and management, read our article here.
The NObreath® FeNO device
The NObreath® was developed in 2008, designed with healthcare professionals and patients in mind. It provides a non-invasive, fairly priced option for FeNO testing, making it more accessible to healthcare providers worldwide.
Featuring an adult and child test mode, the NObreath® is suitable for all settings thanks to its accuracy and portability. It requires an exhalation-only manoeuvre, making it a quick and easy test to take for both adults and children.
The device was designed with the patient in mind and features multiple flow incentive screens. These incentive screens not only engage the patient, but they also ensure a correct flow rate of 50 ml/s, providing an accurate test result.
To learn more about FeNO testing with the NObreath®, visit the website here.
Many deaths from asthma are thought to be preventable, meaning better asthma care is needed. Advances in FeNO testing have been instrumental in improving asthma control, and with increasing recognition in global asthma guidelines, FeNO testing can make a difference.
To learn more about Bedfont® Scientific Limited, world leaders in breath analysis with over 49 years of expertise in the medical device industry, visit the website here.
Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. American journal of respiratory and critical care medicine [Internet]. 2011;184(5):602–15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21885636/
National Institute for Health and Care Excellence. 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
Over 28 million people in the United States (US) have asthma1,2, with the condition named as the leading chronic disease in children, affecting approximately 4.9 million under the age of 182,3. In the US, asthma is one of the most common and costly diseases, and these stark figures highlight why asthma still matters, even in 2026. This Asthma and Allergy Awareness Month, we are exploring the prevalence of asthma and how advancing technology can make a difference.
Asthma places a significant burden on healthcare and the economy, with annual economic costs between 2008 and 2013 contributing to:
$3 billion in losses due to missed work and school days,
$29 billion due to asthma-related mortality,
$50.3 billion in medical costs.
The numbers prove that asthma is common, but it is important to remember that this chronic condition is also manageable; however, outcomes are not equal, and certain populations are disproportionately affected. These disparities are shaped by a combination of structural, social, biological, and behavioural factors. Structural inequities, such as5:
Systemic racism,
Residential segregation,
Discriminatory policies,
Often influence the conditions in which people live, work, and access care. These, in turn, affect social determinants like income, education, housing quality, environmental exposures, and access to healthcare. While biological factors such as genetics and individual behaviours like smoking or medication adherence play a role, it is these broader social and structural inequities that largely drive unequal asthma outcomes across populations.
The hidden problem: Poor asthma control
Millions of people are diagnosed with asthma, with many of them not having the condition well managed. It is estimated that 44% of children with asthma have uncontrolled asthma6, which can lead to exacerbations and severe asthma attacks.
Many asthma patients rely heavily on rescue inhalers, which relieve the immediate symptoms but do not address the underlying airway inflammation. This quick relief can make patients feel in control of their asthma, but without addressing the root cause, asthma remains uncontrolled beneath the surface.
Another contributor to poorly controlled asthma is misdiagnosis. Asthma is not a single condition; it can be allergic/eosinophilic or non-eosinophilic. If the asthma is not diagnosed correctly, this can lead to ineffective or over/under treatment. If the underlying asthma type isn’t properly diagnosed, the treatment cannot be matched to the disease type.
Additionally, a lack of objective measurement in routine care can affect asthma control. Traditionally, asthma management has relied on:
Symptoms,
Patient recall,
Peak flow.
The problem with just focusing on these points is that clinicians may over- or underestimate control, which leads to escalating or reducing treatment inappropriately. Symptoms do not always reflect underlying inflammation and may lead to missed opportunities for early intervention.
This is where better access to objective, point-of-care tools, such as Fractional exhaled Nitric Oxide (FeNO) testing, is needed. Without objective measurement, asthma care often relies on what can be seen and heard, not on what’s happening at the inflammatory level inside.
What is FeNO testing7?
A FeNO test is a quick, easy, non-invasive way to measure airway inflammation, specifically eosinophilic inflammation. When airways are inflamed, higher levels of nitric oxide (NO) are produced. This gas can be detected in exhaled breath, with higher levels indicating inflammation, making FeNO testing a vital tool for asthma care and management.
With FeNO providing a non-invasive, quick point-of-care test, it can help identify type 2 inflammation and predict steroid responsiveness, helping clinicians see inflammation that symptoms alone cannot reveal.
How FeNO improves decision-making
FeNO fits into the whole asthma pathway; it’s not just a diagnostic tool; it can also help treat and manage asthma. Diagnosing and managing this chronic condition isn’t always straightforward, and in the past, healthcare professionals have relied on guesswork. FeNO testing changes that, it can:
Support a diagnosis of asthma,
Guide inhaled corticosteroid (ICS) use,
Monitor medication adherence,
Predict exacerbation risk,
Reduce unnecessary medication escalation.
FeNO is recognised in global guidelines for asthma care and management, with the ATS/ERS guidance positioning FeNO as a practical tool to support diagnosis, guide anti-inflammatory treatment, and monitor airway inflammation, helping clinicians move from symptom-based to more objective asthma care8.
Expanding access to FeNO testing
Objective testing has the potential to transform asthma care, but access remains a challenge. Limited availability outside specialist centres, time constraints in primary care, and geographic inequalities have all contributed to the underuse of tools such as FeNO. The result is a gap between what is possible and what is delivered in everyday care. Advances in technology only matter if people can access them.
Bedfont® Scientific Limited, an innovative MedTech company based in the UK with nearly 50 years of experience in medical breath analysis, has been improving asthma care and management worldwide for over 15 years with its NObreath® FeNO device. Working closely with its US distributor, coVita™, it has been working hard to improve access to FeNO testing by providing a fairly priced, low-maintenance FeNO device.
In 2025, the NObreath® became the allergists’ FeNO device of choice in the US, with Allergy Partners offering FeNO testing with the NObreath® through more than 125 locations in over 20 states. This partnership ensures that FeNO testing is being integrated into routine care, not just specialist settings, allowing more patients to get tested closer to home.
The future of asthma care
This Asthma and Allergy Awareness Month, we want to focus on how early intervention can lead to better long-term outcomes for asthma patients. Advances in technology mean that objective testing, such as FeNO, is more widely accessible, which is vital as biomarker-driven care becomes the standard. FeNO devices like the NObreath® provide clinicians with more insight into underlying inflammation that cannot be seen, enabling improved patient care.
To learn more about the NObreath® FeNO device and how it is improving precision in asthma care, visit the website here.
References
NCHS/DHIS. NHIS Adult Summary Health Statistics [Internet]. Cdc.gov. 2021. Available from: https://data.cdc.gov/National-Center-for-Health-Statistics/NHIS-Adult-Summary-Health-Statistics/25m4-6qqq/about_data
NCHS/DHIS. NHIS Child Summary Health Statistics [Internet]. Cdc.gov. 2021. Available from: https://data.cdc.gov/National-Center-for-Health-Statistics/NHIS-Child-Summary-Health-Statistics/wxz7-ekz9/about_data
Ferrante G, La Grutta S. The Burden of Pediatric Asthma. Frontiers in Pediatrics [Internet]. 2018 Jun 22;6(186):1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023992/
Nurmagambetov T, Kuwahara R, Garbe P. The Economic Burden of Asthma in the United States, 2008–2013. Annals of the American Thoracic Society [Internet]. 2018 Mar;15(3):348–56. Available from: https://pubmed.ncbi.nlm.nih.gov/29323930/
Asthma and Allergy Foundation of America. Asthma Disparities in America [Internet]. Asthma & Allergy Foundation of America. 2020. Available from: https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/
CDC Archives [Internet]. archive.cdc.gov. Available from: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children-2018-2020.htm
What is a FeNO Test? [Internet]. Aaaai.org. 2021. Available from: https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Asthma/What-Is-A-FeNO-Test
Murphy RC, Zhang P, Tejwani V, Khatri SB, Hallstrand TS, Ruminjo JK, et al. Summary for Clinicians: Clinical Practice Guideline for the Use of Fractional Exhaled Nitric Oxide to Guide the Treatment of Asthma. Annals of the American Thoracic Society. 2022 Oct;19(10):1627–30.
The NObreath® FeNO device offers a clear pathway to more effective asthma care, reducing over-reliance on blue inhalers.
Bedfont® Scientific Limited, an innovative med-tech company specialising in medical breath analysis devices, welcomes the new study at University Hospital Southampton exploring whether enhanced asthma check-ups can reduce inhaler use among children. For over 15 years, Bedfont® has supported improved asthma care with its NObreath® Fractional exhaled Nitric Oxide (FeNO) device, which measures airway inflammation through exhaled breath. The quick and easy test provides clinicians with objective insight to guide medication decisions, reduce unnecessary reliever prescriptions, prevent over-reliance on blue inhalers, and help avoid future asthma attacks.
Research has found that children using 6 or more blue reliever inhalers a year are 3-5 times more likely to have an asthma attack1. Reliever inhalers only treat the immediate symptoms and mask the underlying airway inflammation, which can lead to further exacerbations.
The study aims to create a new alert system that automatically notifies general practitioners (GPs) when a child has been prescribed too many inhalers, prompting an immediate check-up. This will allow healthcare professionals to perform a review and help prevent future attacks.
Jason Smith, CEO at Bedfont®, comments, “We welcome the focus this important study brings to the growing problem of reliever inhaler over-use in children, a clear signal that many young people are still not getting the right support for long-term asthma control. Over-reliance on blue inhalers often reflects unmanaged airway inflammation and missed opportunities for targeted treatment. That’s why we continue to advocate for improving the accessibility of FeNO testing in primary care, a guideline-recommended, evidence-based tool that helps clinicians identify and treat underlying inflammation early. With better access to FeNO testing across the UK, we can help reduce unnecessary reliever use, improve outcomes for children, and support GPs in delivering truly personalised asthma care.”
Although FeNO testing is now recommended as a first-line test in UK asthma guidelines, access remains inconsistent across primary care. As a result, many children continue to be managed without the benefit of objective airway inflammation testing, increasing the risk of poorly controlled asthma and over-reliance on reliever inhalers. Reliever inhaler overuse in children is a well-recognised marker of uncontrolled asthma and is associated with a higher risk of exacerbations and emergency admissions.
Greater investment and targeted funding are urgently needed to support the widespread adoption of FeNO technology in primary care, helping clinicians deliver earlier, more accurate diagnoses and reduce preventable harm. To learn more about the NObreath® and how it can help asthma care and management, visit the website here.
References
News I. Southampton researchers lead UK-first study to target “dangerous” asthma inhaler overuse [Internet]. ITV News. 2026 [cited 2026 Mar 3]. Available from: https://www.itv.com/news/meridian/2026-02-25/uk-first-study-targets-dangerous-overuse-of-asthma-inhalers-in-children
Asthma is a chronic lung condition that causes airway inflammation and affects approximately 262 million people worldwide1. Typical symptoms include:
Wheezing,
Breathlessness,
Chest tightness,
Coughing.
When airways are inflamed, breathing can become difficult. Recent Asthma + Lung UK research found that over 42,000 people ended up in emergency care in 2023/24 after visiting 5 or more times within the last 12 months2. These startling numbers highlight the importance of better asthma management to reduce the burden on healthcare systems.
Assessing airway inflammation is key to better asthma management. When a person’s airways become inflamed, higher-than-usual nitric oxide (NO) gases are produced. The easiest way to measure a person’s NO levels is a Fractional exhaled Nitric Oxide (FeNO) test.
What is FeNO testing?
A FeNO test with a device like the NObreath® is a quick, easy, non-invasive and accurate way to measure NO levels in exhaled breath. NO is a marker of eosinophilic airway inflammation, common in allergic asthma. Patients follow on-screen instructions to inhale and then exhale into the device, providing instant results.
FeNO levels are measured in parts per billion (ppb). A high FeNO level indicates airway inflammation and can aid in diagnosing asthma.
ATS/ERS Clinical Guidelines Summary for Interpreting FeNO Levels3,4:
Note: These reflect the ATS and ERS guidelines. FeNO interpretation thresholds may vary between guidelines.
FeNO testing with the NObreath®
The NObreath® is a FeNO device manufactured by Bedfont® Scientific Limited. Bedfont® has over 48 years of knowledge and expertise in designing and manufacturing medical breath analysis devices. The NObreath® has improved asthma management for over 15 years, providing healthcare professionals (HCPs) with a fairly priced solution for FeNO testing. Suitable for both adults and children, the NObreath® is perfect for primary and secondary care settings. For more information on the NObreath®, visit the website here.
Why is FeNO testing useful in asthma?
Airway inflammation cannot be seen; FeNO tests allow HCPs to track any underlying inflammation and, when used alongside an extensive clinical history, can diagnose asthma. Having access to a FeNO device is useful throughout the asthma pathway. Not only does it aid an asthma diagnosis, but it also helps to guide treatment decisions.
Carrying out FeNO tests in routine asthma reviews allows HCPs to:
Tailor inhaled corticosteroid (ICS) therapy,
Identify steroid responsiveness,
Guide step-up or step-down treatment strategies.
A patient who consistently presents with a high FeNO level indicates possible poor adherence to ICS, therefore, instigating conversations about medication use.
FeNO testing is incorporated into worldwide guidelines. Joint guidelines by the National Institute of Health Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) now recommend FeNO as a first-line test for asthma diagnosis.
Future of FeNO testing.
The biggest challenge with FeNO testing is accessibility; unfortunately, some areas do not have access to a FeNO device. In a recent interview with Carol Stonham MBE, we discussed the issues around funding. In some areas, the Integrated Care Board (ICB) will pay for it, but in others, it is down to the Primary Care Network (PCN). However, if the PCN does not deem it a priority, it comes down to the individual General Practice (GP) surgeries.
Looking back at the shocking statistics at the beginning of this blog, it is clear that better asthma management is needed. FeNO is a valuable tool in modern asthma management. It guides HCPs to understand the underlying airway inflammation in asthma, leading to better patient outcomes.
With the NICE/BTS/SIGN guidelines update, FeNO testing is recommended as a first-line test for asthma diagnosis and management in adults. This means access to FeNO needs to improve.
For more information on FeNO testing and its central role in asthma care in the joint NICE/BTS/SIGN guidelines, click here to read our article on the guideline updates and FeNO testing.
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. [cited 2025 May 14] Available from: https://pubmed.ncbi.nlm.nih.gov/35169025/
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. [cited 2025 May 14] Available from: https://pubmed.ncbi.nlm.nih.gov/21885636/
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® 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®.”
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.
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/
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.
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.
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The NObreath® device enhances access toFeNO 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?
