Auteur/autrice : sian

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 guidelines^4,5:

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 guidelines^7,8:

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 guidelines^4,5:

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 guidelines^7,8:

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 17^th 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 17^th 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 22^nd 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 22^nd April 2025]. Available from: https://www.healthline.com/health/asthma/feno-test-asthma?c=1285499318383#takeaway

HMBT World Digestive Health Day (WDHD) is observed annually on May 29 . Established in 2004, the day commemorates the founding of the World Gastroenterology Organization (WGO) in 1958.WDHD aims to raise global awareness about the prevention, prevalence, diagnosis, management, and treatment of digestive disorders.

The theme for 2025 is Your Digestive Health: Nourish to Flourish . In this blog, we will explore the importance of digestive health, how Hydrogen-Methane Breath Testing (HMBT) can help, and why it’s an innovative tool for aiding in the diagnosis of gastrointestinal (GI) disorders.

Why is gut health important?

The gut is responsible for breaking down and absorbing nutrients from the foods you eat. The nutrients absorbed help support the body’s functions². Poor gut health can have a significant impact on everyday life, presenting symptoms such as:

• Persistent bloating and gas³,
• Irregular bowel movements³,
• Skin issues³,
• Chronic fatigue and low energy levels³.

Maintaining good gut health has many benefits, from a stronger immune system to improved mental health².

Factors like diet, stress, medication, and infections can negatively affect digestion, leading to GI disorders such as Small Intestinal Bacterial Overgrowth (SIBO) and carbohydrate malabsorption.

SIBO⁴

The symptoms of SIBO are very similar to those of irritable bowel syndrome (IBS).

Carbohydrate Malabsorption⁵

Carbohydrate Malabsorption occurs when the body has difficulty digesting and absorbing certain carbohydrates in the small intestine. This leads to the fermentation of undigested carbohydrates in the colon, which can cause gas, bloating, diarrhoea, and discomfort.

The Role of HMBT in Gut Health

HMBT is a non-invasive diagnostic tool for detecting conditions like SIBO and carbohydrate malabsorption. The test works by measuring the levels of hydrogen and methane gas on exhaled breath after consuming specific sugars.

Introducing the Gastroylzer® Range

The Gastrolyzer® is a range of HMBT breath analysis devices that aid the diagnosis of various GI disorders.

How HMBT Works

It’s easy to take a HMBT. Depending on the condition being investigated, the patient consumes a test solution containing either glucose, lactulose, or lactose. Breath samples are then collected at regular intervals, and hydrogen and methane gases are measured. It is also possible to test remotely with the GastroCH₄ECK® Gastrolyzer® using breath bags.

Benefits of Using HMBT for Gut Health

Studies have found that over 40% of the world’s population experience Functional Gastrointestinal Disorders (FGIDs)⁶. The symptoms can significantly impact a person’s life, and knowing the resources available to help is important. A HMBT can provide clarity and guide personalised treatment options. Some key benefits include:

Nourish Your Gut

Supporting a healthy gut starts with giving it the right fuel for a balanced gut microbiome. The following habits can help to promote better gut health:

• Eat more fibre⁷.
• Limit processed foods and sugars⁷.
• Stay hydrated⁷.
• Exercise⁷.
• Manage stress⁷.

Gut health is crucial to overall health. By prioritising digestion, eating a balanced diet rich in fibre, staying hydrated and managing stress, you can support your microbiome and enhance digestive function. This World Digestive Health Day, take the opportunity to listen to your gut and make choices that support a healthier you. For more information on how to take control of your digestive health, read our article ‘Taking Control of your digestive health – Importance of not self-diagnosing’ or visit gastrolyzer.com for more information on hydrogen-methane breath testing.

References

1. WDHD [Internet]. wdhd.worldgastroenterology.org. [Cited 2025 Mar 24]. Available from: https://wdhd.worldgastroenterology.org/
2. Department of Health & Human Services. Gut health [Internet]. www.betterhealth.vic.gov.au. 2023. [Cited 2025 Mar 13]. Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/gut-health
3. Graham D. Why Your Gut Health Matters More Than You Think | Ferrocalm [Internet]. Ferrocalm. 2025 [cited 2025 Mar 13]. Available from: https://ferrocalm.com/why-your-gut-health-matters-more-than-you-think/
4. Jamie Eske . What to know about SIBO and its treatment [Internet]. Medicalnewstoday.com. Medical News Today; 2019 [cited 2025 Apr 3]. Available from: https://www.medicalnewstoday.com/articles/324475#symptoms
5. Peter Born. Carbohydrate malabsorption in patients with non-specific abdominal complaints. World Journal of Gastroenterology : WJG [Internet]. 2007 Nov 21;13(43):5687–91. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171253/
6. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2020 Apr;160(1). [Internet]. [Cited 2025 Mar 13]. Available from: https://www.gastrojournal.org/article/S0016-5085(20)30487-X/fulltext
7. Services D of H & H. Gut health [Internet]. www.betterhealth.vic.gov.au. [Cited 2025 Mar 13]. Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/gut-health#how-to-improve-your-gut-health

Bedfont® Scientific Limited iCOquit® Smokerlyzer® features in award winning app to aid in smoking cessation.

WayBetter is a U.S.-based digital health company dedicated to helping people make sustainable changes in their health behaviours through gamification, social support, and financial incentives. With the previous success of the DietBet and StepBet apps, QuitBet was developed to encourage smoking cessation efforts. The trial, which had 245 participants, saw people who smoke pay $30 to participate in a 4-week game designed to promote and educate players on the benefits of quitting smoking. Participants tracked their breath carbon monoxide (CO) levels daily using Bedfont’s iCOquit® CO device.

Bedfont®, who are world leaders in breath analysis, manufactures the iCOquit® Smokerlyzer® device. This personal CO device aids in smoking cessation by allowing users to monitor their CO levels as often as needed during their quit attempt. By tracking CO levels, the iCOquit® is a visual motivational aid for people quitting smoking.

“We are incredibly proud that our iCOquit® Smokerlyzer® CO monitoring device played a role in supporting users on their quit journey,” said Jason Smith, CEO of Bedfont® Scientific Limited. “This recognition highlights the power of combining behavioural science with real-time biometric feedback to create meaningful, lasting change in people’s lives.”

Dr. Erika Bloom personally presented the results from WayBetter’s clinical trial of QuitBet, which saw 40% of the 245 participants (98 participants) quit smoking for 4 weeks and be declared winners. Winners split the total pot, so they received a refund of their $30 plus an additional $50 on average.

WayBetter has seen significant success with previous apps designed to improve people’s health and well-being, with over 1.5 million total registered paying customers in its history. WayBetter is now working toward launching QuitBet as a commercial product, fuelling the company’s mission to use technology to make health behaviour change easier, social, and more fun.

The inclusion of the iCOquit® device demonstrates how powerful CO monitoring can be, not just as a tool for behavioral change, but as a key player in shaping the future of personal health. Bedfont® intends to continue innovating and expanding the reach of its technology to help even more people make lasting, life-changing decisions.

Visit the website here for more information on the iCOquit® Smokerlyzer® device and how it is helping people worldwide give up smoking.

Families and four-legged friends walked among the bluebells to make a difference for Heart of Kent Hospice.

On Sunday, May 4^th, Bedfont® teamed up with joint headline sponsors NewMed Limited and participated in this year’s Bluebell Walk, hosted by Heart of Kent Hospice. The Bluebell Walk is an annual event that brings the local community together and raises vital funds for Heart of Kent Hospice to ensure their crucial care for adults with terminal illnesses, their families, friends, and carers can continue.

David Dadswell, Heart of Kent Hospice Corporate Partnerships Manager, said, “We were thrilled to have the support of Bedfont® and NewMed for the second year running, sponsoring one of our flagship events. Knowing that our values align and our visions of compassion and community are mirrored enables events like these to have a greater impact”.

The walk, which took participants through the beautiful bluebells and woodland of the Kent Downs, was a huge success. The sun shone bright and added to the day’s atmosphere, with hundreds of people participating. It is estimated that the event raised approximately £40,000, eclipsing last year’s total of £28,000.

“We’re incredibly proud to continue our support of Heart of Kent Hospice and to be part of such a meaningful community event.” Said Jason Smith, CEO at Bedfont®. “The Bluebell Walk reflects our values as a company: connection, compassion, and making a positive impact where it matters most. It’s inspiring to see so many people come together to support a cause that truly changes lives.”

Bedfont® will continue supporting Heart of Kent Hospice throughout 2025. Follow the journey on social media and learn more about Bedfont® by visiting https://www.bedfont.com/.

The latest UK asthma guidelines¹ have identified how Fractional exhaled Nitric Oxide (FeNO) testing fits into the diagnosis and ongoing management of asthma. The guidelines are based on the latest clinical evidence, cost-effectiveness, and cost-effective modelling, so they are strongly recommended for use. But what does that mean for the individual patient as they travel along their asthma journey? Let’s consider a patient.

Meet Ramila. She is 19 and presents to her GP with symptoms of chest tightness, wheeze, and shortness of breath. Initially, it was only related to exercise, but now it happens more often, and Ramila notices it, especially when she wakes in the morning. It is not constant, so Ramila has been putting off seeing her GP.

Ramila remembers having an inhaler, a blue one, she thinks when she was younger, but has never had a formal diagnosis of asthma. Her older brother has asthma, as does her aunt. Ramila has never had hay fever or eczema symptoms, has no allergies, and is otherwise well.

The GP listens to Ramila’s chest, which is normal. This does not rule out asthma when she is asymptomatic. As Ramila’s GP has access to FeNO within the practice, they can perform a FeNO test at this appointment. The result is 61 parts per billion (ppb), which, given the history and symptoms Ramila describes, supports a diagnosis of asthma. The latest guideline recommendation is that this single test is enough to confirm a diagnosis of asthma, and Ramila can begin treatment without delay.

Had the GP not had access to FeNO or had there been a delay in accessing the test, they could have ordered a blood test to look at Ramila’s level of eosinophils. This would mean there would be a delay in diagnosis, and potentially in treatment, whilst the test was processed, as this is not a near-patient test. It would likely have also resulted in Ramila having to make another appointment, putting extra pressure on primary care services and her busy schedule.

Once asthma is diagnosed, Ramila can start on a treatment regimen. If she is having occasional symptoms, then treatment with a Formoterol-containing inhaled steroid combination inhaler used on an as-needed basis is recommended. This is an Anti-Inflammatory Reliever (AIR) regimen. As Ramila is having daily symptoms, it would be appropriate to move to a Maintenance And Reliever Therapy (MART) regimen. This would still involve the initiation of a Formoterol-containing inhaled steroid combination inhaler, but used regularly each morning and evening, and on an as-needed basis for symptom control. A short-acting bronchodilator is not indicated in the AIR or MART regimen. The first line choice of device type should be a dry powder if Ramila can use it. This has a much lower carbon footprint.

Ramila would need to be shown how to use the inhaler device correctly, have some education regarding what asthma is and how the medication works, and start to produce a personalised asthma action plan with the clinician. This will help Ramila to know what good asthma control looks like and what medication she should take to achieve this. It will also help her recognise any deterioration in her symptom control and when things need urgent advice. The plan should tell Ramila whom to contact, when her symptoms should be less well controlled, and what to do in the more urgent situation.

This is also a good opportunity for more general health advice around smoking, alcohol, weight management and maintaining an active lifestyle.

Ramila will be invited to attend regular reviews. The guidelines suggest this as a good time to check a FeNO level. It is an opportunity to reinforce patient education, and FeNO is a good tool to demonstrate whether the current medication regimen controls airway inflammation or not. If the FeNO result is raised, it opens a dialogue around how well Ramila understands the diagnosis of asthma and how her prescribed inhalers work. Ramila has her FeNO checked, and it has crept up to 52 ppb, having previously been settled around 18 ppb. After discussion, it became clear Ramila has become more complacent about her asthma and is using her inhaler less regularly and had been using it just as she needed it, but on reflection, she could see that her symptoms were not as well controlled as they had been. FeNO is a good tool to uncover nonadherence with medication and open the conversation in a non-judgmental way.

The guidelines also suggest checking FeNO before and after changing medication. It can help decide what treatment might be appropriate and help assess the response to treatment. This is particularly pertinent when Ramila attends with poor asthma control a few years later. She has good inhaler technique and has been using her inhaler with a MART regimen with good adherence. Despite this, her symptoms are increasing. She had been increased from a low-dose MART regimen to a moderate-dose MART regimen at a previous review (increasing the steroid dose of the combination inhaler), which had been controlling her symptoms for some time until recently. In this instance, the guidelines suggest checking FeNO to guide the next treatment decision. Ramila was found to have a normal FeNO (21 ppb), but with increasing symptoms, will need an increase in treatment. With a normal FeNO (indicating that eosinophilic airway inflammation is well controlled), the clinician is guided to add additional treatment. This could be Montelukast, taken orally once a day, in addition to the MART regimen, or the addition of a Long-Acting Muscarinic Antagonist (LAMA) as inhaled therapy. The options, advantages and potential side effects were discussed with Ramila, who opted to try Montelukast.

Had Ramila demonstrated a raised FeNO, the treatment recommendation would have been directed towards further anti-inflammatory therapy. The options here are to prescribe high-dose inhaled steroids or initiate biologic therapy. Both options would be considered, and decisions would be made with Ramila and a respiratory physician, so Ramila would need a referral for this. Without FeNO to guide decisions, a referral could be unnecessarily delayed.

It is also worth considering how we reduce asthma therapy, asthma is a variable condition, so treatment needs to be titrated up and down at times of variation. Had Ramila been on a moderate dose MART regime and been asymptomatic for at least 3 months, not experienced an exacerbation and not needing to use additional rescue doses of medication, all indicating good symptom control, it would be worth discussing stepping back to a low dose MART regime, reducing the steroid component on the combination inhaler. FeNO is a useful tool to guide this process if the person fits the criteria for good control. If Ramila’s FeNO test result was also low, indicating that eosinophilic airway inflammation was well controlled, it would be a good time to discuss reducing the steroid dose, provided she was not approaching a known trigger time of year. However, stepping the inhaled steroid dose would not be wise if it did not indicate good inflammation control in that it was even moderately raised.

Although the associations seem to sit around using FeNO in diagnosing asthma, the latest iteration of the UK guidelines demonstrates the importance of FeNO testing as part of the whole asthma patient pathway. Easy access without delay will enhance the accuracy of care delivered to people presenting with asthma in primary care.

FeNO testing with the NObreath®:

Bedfont® Scientific Limited, are world leaders in breath analysis, with over 48 years of expertise and knowledge in designing and manufacturing breath analysis devices. Bedfont® are committed to improving patient safety through innovating breath analysis devices, such as the NObreath®. The device is a portable handheld FeNO device, used by healthcare professionals to aid in the diagnosis and treatment of asthma.

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

References:

1. National Institute for Health ad Care Excellence (2024) Asthma: diagnosis monitoring and chronic asthma management (BTS, NICE, SIGN). Available from https://www.nice.org.uk/guidance/ng245 [Last accessed 11.4.2025]

Why FeNO testing is a game-changer

Asthma causes airway inflammation; more nitric oxide (NO) is produced when airways are inflamed. A FeNO test measures NO levels; a high FeNO level suggests airway inflammation and aids an asthma diagnosis but also guides healthcare professionals on their next steps in treatment.

The most recent guidelines for asthma care and management from the National Institute of Health and Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) now recommend a FeNO test as an initial test for diagnosis and asthma management. A FeNO test is quick, easy to use, and fits within a typical 10-15-minute consultation.

Asthma care should not be a guessing game, but without access to the right tools, that is exactly what it becomes.

Bedfont® Scientific Limited promotes FeNO testing for asthma management.

Research from Asthma + Lung UK has found a significant rise in Accident and Emergency (A&E) visits from people experiencing breathing issues such as asthma. Asthma + Lung UK is a British charity formed in January 2020, with a dedication to improving respiratory health by focusing on asthma and lung diseases. The latest research shows over 42,000 patients ended up in emergency care in 2023/24 after visiting five or more times within the last 12 months, a 22.9% rise compared to the previous year¹. Bedfont® Scientific Limited, a world leader in breath analysis, is calling for a wider adoption of Fractional exhaled Nitric Oxide (FeNO) testing to improve asthma management and reduce unnecessary hospitalisations.

By including FeNO testing in regular asthma reviews, healthcare professionals can check a patient’s adherence to medication and adjust treatment plans. This allows better asthma control, which, in turn, reduces the need for emergency care.

An Asthma + Lung UK poll of 3,428 patients found that 49% said follow-up appointments were not offered for their condition¹. The latest guidelines state that follow-up appointments and annual treatment reviews should be conducted for anyone who has ended up in emergency care².

“Current NHS data shows a worrying pattern, asthma patients are repeatedly visiting hospitals without receiving the follow-up care they need,” said Jason Smith, CEO at Bedfont®. “FeNO testing can bridge this gap by providing early, precise insight into airway inflammation, ensuring patients receive the right treatment at the right time.”

With asthma-related hospital visits on the rise, Bedfont® joins Asthma + Lung UK in calling for the government to prioritise lung health in the upcoming 10-year health plan to prevent lung health from “falling to the bottom of the pile.” Greater investment in FeNO testing in primary care could reduce asthma hospital admissions.

Bedfont® is dedicated to improving respiratory health through innovative technology. The NObreath® FeNO device helps healthcare professionals diagnose and manage asthma accurately, reducing exacerbations and unnecessary hospital visits. Click here to discover how the NObreath® revolutionises asthma care.

References

1. Surge in repeat hospital visits for lung conditions [Internet]. Asthma + Lung UK. 2025 [cited 2025 Mar 18]. Available from: https://www.asthmaandlung.org.uk/media/press-releases/surge-repeat-hospital-visits-lung-conditions
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

How FeNO testing with the NObreath® can aid an early asthma diagnosis in children.

As the world prepares to observe World Health Day on April 7^th, 2025, Bedfont® Scientific Limited highlights the importance of early and accurate asthma diagnosis with its innovative NObreath® Fractional exhaled Nitric Oxide (FeNO) device. Whilst this year’s theme, Healthy Beginnings, Hopeful Futures, focuses on pregnancy and early life, Bedfont® is highlighting how FeNO testing revolutionises asthma care, ensuring children grow up with better respiratory health.

Over 262 million people worldwide have asthma, with 9.1% of them being children (aged 6-7)¹. Undiagnosed or poorly managed asthma can lead to severe breathing difficulties, missed school days, and emergency hospital visits. Traditional tests like spirometry and peak flow meters do not always detect underlying airway inflammation, a common asthma symptom.

“For children, early intervention is vital,” says Jason Smith, CEO at Bedfont®. “The NObreath® is transforming how we detect and manage childhood asthma, giving young patients the best possible start in life. This World Health Day, we want to raise awareness of the importance of proactive asthma management and how FeNO testing can support a healthier future for millions of children worldwide.”

In November 2024, the National Institute of Care Excellence (NICE), the British Thoracic Society (BTS), and the Scottish Intercollegiate Guidelines Network (SIGN) published joint guidelines on asthma diagnosis, monitoring, and chronic asthma management. The guidelines recommend FeNO testing as a first-line test for asthma diagnosis in children with symptoms suggestive of asthma.

Carol Stonham MBE, NHS Gloucestershire ICB SW Respiratory network co-clinical lead, comments, “Asthma is the commonest long-term condition we see in children. If we can work with them to establish an early and accurate diagnosis and help them understand what asthma is and how their inhalers work, they will be able to manage their asthma more effectively and grow into young adults who are confident in getting asthma management right. FeNO is vital for the initial diagnosis but is also a great tool for fostering understanding of the inflammation we know is there but can’t see. With this understanding, children and their parents or carers can recognise when symptoms increase and know when to adjust inhalers or seek help.”

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

As World Health Day 2025 approaches, Bedfont® is committed to advancing respiratory health and ensuring that FeNO testing is available worldwide. This will allow healthcare professionals to help children breathe easier, stay active, and live healthier lives.

To read more about World Health Day 2025 and how FeNO testing is helping children with asthma, read our blog ‘World Health Day 2025: How FeNO Testing is Helping Children with Asthma’ [insert link to blog]

Read more: https://www.bedfont.com/world-health-day-2025-how-feno-testing-is-helping-children-with-asthma/

References

1. The Global Asthma Report 2022 [cited 26/2/25] Available from https://globalasthmareport.org/burden/burden.php

World Health Day is celebrated annually on April 7th to recognise the World Health Organisation’s (WHO) founding in 1948. The day aims to raise awareness about global health issues and efforts to address them. In 2019, 262 million people worldwide had asthma, with 9.1% of those being children (aged 6-7)1, experiencing this chronic condition early in life.

What is World Health Day?

World Health Day educates people worldwide about critical health issues and promotes policies and initiatives that improve health access and quality. This is a global collaboration between governments, healthcare organisations and communities to work toward better health for all.

Each year, WHO selects a theme that reflects current and global health concerns. The theme for 2025 is “Healthy Beginnings, Hopeful Futures.” This year, the theme focuses on pregnancy and early-life health interventions, highlighting the importance of providing healthcare, education, and resources from infancy to ensure healthier futures.

World Health Day 2025 Theme: « Healthy Beginnings, Hopeful Futures »

Whilst the theme focuses on pregnancy and early life, this blog will look at the importance of an early asthma diagnosis in children, ensuring they grow up with fewer health complications.

What is asthma?²

Asthma is a chronic lung disease that causes inflammation in the airways, making breathing difficult. It can affect people of all ages and often begins in childhood. There is no cure, but simple treatments are available that can help keep the symptoms under control. Asthma does not have to impact a person’s life significantly.

Asthma is a combination of variable symptoms that may differ over weeks and months. The common
symptoms are:

• Wheezing
• Breathlessness
• Chest Tightness
• Coughing

Impact of asthma on children³

Asthma can significantly impact a child’s life. Symptoms can affect various aspects of life, including reduced physical activity, missed school days, anxiety, and stress.

Every child is different, and triggers vary. Symptoms can sometimes happen hours after coming into contact with an asthma trigger, making it difficult to work out what has caused the symptoms. Once a trigger has been identified, it’s best to avoid them if possible.

The importance of an early diagnosis and monitoring

Diagnosing asthma early is essential; many children remain undiagnosed or misdiagnosed, which leads to uncontrolled asthma and worsening symptoms over time. In the UK, asthma is one of the top three causes of emergency admissions to hospitals, with 75% of these admissions being avoidable through the implementation of simple interventions such as regular asthma reviews, correct inhaler technique and having a written asthma action plan⁴.

Asthma diagnosis in children

Traditional asthma tests such as spirometry may not always be practical in young children because they often lack the cognitive ability to understand and perform the breathing manoeuvres needed for an accurate test. Due to its non-invasive nature, fractional exhaled nitric oxide (FeNO) testing is a great option for children to assist in an asthma diagnosis.

What is FeNO testing?

FeNO testing in children

The British Thoracic Society (BTS), the National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN) released a joint asthma guideline in November 2024, recommending FeNO testing as the first-line test for asthma diagnosis in children. The new NICE/BTS/SIGN guidelines state that children and young people (aged 5-16) with symptoms suggestive of asthma can have a positive asthma diagnosis if FeNO levels are 35 ppb or higher⁵. Catching inflammation early can prevent severe asthma attacks, leading to better long-term health. For more information on the updated asthma guidelines, read our article here.

Conclusion

Asthma can affect a child’s physical health, education, and emotional well-being, but with an early diagnosis and correct management, children can lead healthy, active lives. On World Health Day 2025, let’s prioritise early asthma diagnosis and support children in having Healthy beginnings for hopeful futures.

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

References

1. The Global Asthma Report 2022 [cited 26/2/25] Available from https://globalasthmareport.org/burden/burden.php
2. World Health Organization. Asthma [Internet]. World Health Organization. 2024. [cited 26/2/25] Available from: https://www.who.int/news-room/fact-sheets/detail/asthma
3. Mayo Clinic Staff. Childhood asthma – Symptoms and causes [Internet]. Mayo Clinic. 2023. Available from: https://www.mayoclinic.org/diseases-conditions/childhood-asthma/symptoms-causes/syc-20351507
4. Children and young people’s asthma fact sheet [cited 26/2/25] Available from https://www.transformationpartners.nhs.uk/children-and-young-peoples-asthma-fact-sheet/#:~:text=1%20in%2011%20children%20and,symptoms%20in%20the%20previous%20week.
5. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) [cited 26/2/25] Available from https://www.nice.org.uk/guidance/ng245/chapter/Recommendations

Local med-tech company Bedfont® Scientific is proud to announce its ranking in the prestigious MegaGrowth 50 awards.

Celebrated annually, the MegaGrowth 50 awards recognise the 50 fastest-growing privately owned businesses in Kent and Medway. Bedfont® Scientific, world leaders in breath analysis with over 48 years of experience designing and manufacturing medical breath analysis devices, was thrilled to feature in the top 50 for 2025.

The awards, organised by Kreston Reeves, Brachers, and the Kent Invicta Chamber of Commerce are based on the average turnover growth of companies with a minimum turnover of £1 million, as reported in full accounts registered at Companies House over the past four years. Bedfont® has shown steady growth, with high expectations for the current financial year.

The rankings were unveiled during an awards breakfast at the Tudor Park Marriott Hotel, Maidstone, where local businesses celebrated companies making a significant impact on the local and national economies. The rankings were announced in reverse order, and Bedfont® proudly placed 28 in the list.

Jason Smith, CEO at Bedfont® Scientific, said, “Being named among Kent’s fastest-growing businesses is an incredible honour and a testament to the hard work, passion, and dedication of our entire team. Ranking 28 in the MegaGrowth 50 awards is a huge achievement that reflects our commitment to excellence and innovation. I’m immensely proud of what we’ve accomplished and excited about the opportunities ahead. I’d also like to extend my congratulations to all the other businesses who made the list, your success stories inspire us all and highlight the strength and resilience of Kent’s business community.”

Following this recognition, Bedfont® plans to grow and continue its global impact by providing cutting-edge breath analysis medical products to the highest standards through technical innovation and professional business practice.

For more information on Bedfont® visit www.bedfont.com or follow @BedfontLtd on social media.