Reviving Lung Health: How FeNO Testing Can Help Millions Suffering from Lung Conditions

NObreath FeNO Monitor

As winter draws in, the NHS braces for an influx of patients infected with common respiratory viruses. For those with respiratory conditions, such as the 5.4 million asthma sufferers in the UK, the colder months pose an especially daunting threat.1 Constricted airways, breathlessness, and tightness of the chest are typical yet distressing symptoms of asthma, an inflammatory disorder affecting around 9% of the population and capable of increasing vulnerability to respiratory infections.1,2

Beyond the physical and mental strain caused by asthma, a DALY rate of 350 per 100,000 indicates a significant burden of asthma-related disability in the UK population.3 This is reflected in the reported 60,000 hospital admissions and 200,000 bed days for asthma sufferers each year.1 Asthma can also be life-threatening, with asthma attacks claiming the lives of three people each day.1

The human toll of asthma has led to a significant economic burden. This year, the direct cost of asthma in England – encompassing NHS expenses, the impact of greenhouse gas emissions, and patient travel costs – has exceeded £1.2 billion.1 Collectively, lung conditions, including asthma, place an annual £9.6 billion burden on the NHS and exacerbate winter healthcare pressures, as individuals with these conditions are more susceptible to respiratory illnesses and cold weather.1 Asthma has become more than a personal health concern; it is a public health and economic crisis.

Compounding a Crisis: Inadequate Diagnostic Testing Impedes Effective Decision-Making

A report published in 2023 by the British Charity Asthma + Lung UK highlights the concerning state of lung healthcare in England. Despite lung disease being the third leading cause of death, individuals suffering from breathlessness frequently wait years for a formal diagnosis, while others remain undiagnosed or are misdiagnosed.1 One study found that an asthmatic diagnosis could not be established in over 30% of adults who had previously received positive diagnoses.4 The scale of this issue is brought into focus when realizing that an estimated 750,000 people are misdiagnosed as asthmatic in England, and attendant financial repercussions are estimated at £132 million each year.1

The reasons behind these apparent oversights are complex. One contributing factor involves funding restrictions and a lack of accessibility to diagnostic tests, undermining the veracity of primary care diagnoses. As uncovered in a PwC analysis, current deficiencies in testing are estimated to cost England £2.2 billion, primarily due to preventable hospital stays and treatments.5

To recoup some of these costs and alleviate pressure on the NHS, Asthma + Lung UK proposed the following measures. By fully funding diagnostic testing such as FeNO, reinstating nationwide spirometry, and maximizing the potential of community diagnostic centers and primary care for diagnoses, £307 million could be saved, and 273,000 beds could be made available – with over a third of these during the critical winter period. This figure dwarfs the £250 million in emergency funds that the UK government set aside to create 5,000 extra NHS hospital beds for this winter.1

FeNO Testing: Tackling the Burden of Lung Conditions, One Breath at a Time

As one of the three recommendations proposed by Asthma + Lung UK, improving diagnostic testing appears realistically achievable. NICE recommends a single objective test for measuring airway inflammation in the diagnosis of asthma, fractional exhaled nitric oxide (FeNO).6 This test works by measuring nitric oxide, a naturally occurring gas produced by cells lining the airways to help combat inflammation. In individuals with respiratory conditions, especially asthma, there is often increased production of nitric oxide due to localized inflammation. During a FeNO test, the individual breathes into a specialized device, such as the NObreath® by Bedfont Scientific Ltd, which is designed to capture and analyze its nitric oxide content. With extreme sensitivity, the device measures the concentration of nitric oxide in parts per billion. Through reading the output of the device, valuable information about the degree of inflammation in the individual’s airways can be discerned. Higher FeNO levels are indicative of greater airway inflammation, which is often associated with conditions like asthma.5

The NObreath®, developed by Bedfont Scientific Ltd., is a non-invasive FeNO monitor suitable for both adult and child patients. Conforming to ATS & ERS guidelines, the NObreath® works using an easy exhale-only technique and on-screen visual motivation. After a breath sample is collected and analyzed, airway inflammation can be assessed, and responses to treatment can be monitored. Furthermore, a patient interpretation guide streamlines result analysis, enabling healthcare providers to make informed decisions.7

While the NObreath® offers a simple and cost-effective solution to asthma diagnosis, FeNO tests and solutions essential to accurately evaluating lung health remain largely unavailable in primary care.5,7 A comprehensive analysis conducted by the PwC suggests that if FeNO tests were to be made universally accessible to GPs across England, optimization of asthma treatment could save around £100 million.1 Such a finding not only underscores the cost-effectiveness of FeNO testing but emphasizes its potential to enhance patient outcomes by ensuring accurate diagnoses and tailored treatments.

A Nation Blue in the Face: Heeding the Call for Improved Diagnostic Testing

The asthma crisis in England is a multifaceted challenge involving misdiagnoses and financial strain on the NHS. FeNO testing represents a solution that can aid in the accurate diagnosis of lung conditions, such as asthma, and save millions of lives when made widely available to GPs across the country and integrated into primary care. It is crucial that everyone suspected of lung conditions, such as asthma, has access to FeNO tests and that those who undergo testing receive precise diagnoses.

By embracing FeNO testing as a cornerstone of asthma management, we can significantly improve the quality of life for asthma sufferers, reduce healthcare costs, and alleviate the burden on the NHS. The time to act is now for the benefit of patients and the healthcare system nationwide. Contact Bedfont Scientific Ltd. to find out what solutions are available to aid in this journey to more accessible testing.

References and further reading

  1. Saving Your Breath: How Better Lung Health Benefits Us All. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/saving-your-breath-report
  2. Sharma S, et al. (2022). Vulnerability for Respiratory Infections in Asthma Patients: A Systematic Review. Cureus. http://doi.10.7759/cureus.28839
  3. Nunes C, et al. (2017). Asthma costs and social impact. Asthma Research and Practice. http://doi.10.1186/s40733-016-0029-3
  4. Aaron SD, et al. (2017). Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. http://doi.10.1001/jama.2016.19627
  5. ‘Abysmal’ lack of testing for lung conditions is forcing GPs to play a ‘guessing game’ with diagnosis. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/media/press-releases/abysmal-lack-testing-lung-conditions-forcing-gps-play-guessing-game-diagnosis (Accessed on 09 October 2023).
  6. Asthma: diagnosis, monitoring and chronic asthma management. NICE. Available at: https://www.nice.org.uk/guidance/ng80/chapter/Recommendations#objective-tests- for-diagnosing-asthma-in-adults-young-people-and-children-aged-5-and-over (Accessed on 09 October 2023).
  7. Nobreath. Available at: https://www.nobreathfeno.com/us/ (Accessed on 09 October 2023).