{"id":9440,"date":"2025-05-28T11:25:03","date_gmt":"2025-05-28T11:25:03","guid":{"rendered":"https:\/\/www.bedfont.com\/?p=9440"},"modified":"2025-12-22T15:48:03","modified_gmt":"2025-12-22T15:48:03","slug":"clinical-guidelines-on-feno","status":"publish","type":"post","link":"https:\/\/www.bedfont.com\/sv\/clinical-guidelines-on-feno\/","title":{"rendered":"Clinical guidelines on FeNO"},"content":{"rendered":"\n

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.<\/p>\n\n\n\n

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Guidelines<\/strong><\/p>\n\n\n\n

NICE, BTS, and SIGN guidelines1<\/sup>:<\/strong><\/p>\n\n\n\n

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.<\/p>\n\n\n\n

The guideline can be read here.<\/a><\/p>\n\n\n\n

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ERS guidelines2<\/sup>:<\/strong><\/p>\n\n\n\n

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\u2005years old with suspected asthma (conditional recommendation for the intervention, moderate quality of evidence).<\/p>\n\n\n\n

The guideline can be read here.<\/a><\/p>\n\n\n\n

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DGP guidelines3<\/sup>:<\/strong><\/p>\n\n\n\n

The German Respiratory Society (The Deutsche Gesellschaft f\u00fcr Pneumologie und Beatmungsmedizin, DGP) is the largest and oldest medical professional organisation for respiratory disorders. The latest guidelines on asthma, published in 2023, titled \u2018S2K guidelines for specialist diagnosis and therapy of asthma\u2019. FeNO is described as an indispensable component of specialist asthma diagnostics.<\/p>\n\n\n\n

The guideline can be read here.<\/a><\/p>\n\n\n\n

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ATS guidelines4,5<\/sup>:<\/strong><\/p>\n\n\n\n

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.<\/p>\n\n\n\n

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 \u201cThe 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.\u201d<\/em>6<\/sup>.<\/p>\n\n\n\n

 The guideline can be read here<\/a> and here.<\/a><\/p>\n\n\n\n

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GINA guidelines7,8<\/sup>:<\/strong><\/p>\n\n\n\n

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\u2019s 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.<\/p>\n\n\n\n

The guideline can be read here<\/a> and here.<\/a><\/p>\n\n\n\n

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Reimbursement for FeNO:<\/strong><\/p>\n\n\n\n

Each country has different policies regarding reimbursement for FeNO testing. In England, practices strive to accomplish maximal Quality and Outcomes Framework (QoF)9<\/sup> 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.<\/p>\n\n\n\n

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<\/sup>.<\/p>\n\n\n\n

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Why guidelines matter:<\/strong><\/p>\n\n\n\n

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!<\/p>\n\n\n\n

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Key Takeaways<\/strong><\/p>\n\n\n\n

NICE, BTS, SIGN guidelines1<\/sup>:<\/strong><\/p>\n\n\n\n

Diagnosis:<\/strong><\/p>\n\n\n\n