Clinical Applications of

Fractional Nitric Oxide

(NO) Concentration
in Exhaled Breath (F e NO)

Highlights From the 2011 Official

American Thoracic Society (ATS)
Clinical Practice Guideline1

Published September 1, 2011, in the

American Journal of Respiratory
and Critical Care Medicine
Asthma:
A n I n f l a m m at o ry P r o c e s s

W h at i s a s t h m a ?

The National Asthma Education and Prevention

Program’s Expert Panel Report 3 (NAEPP EPR-3)
defines asthma as a chronic inflammatory disorder of
the airways, in which airway inflammation contributes
to airway hyperresponsiveness, airflow limitation,
respiratory symptoms, and disease chronicity.2

Ma n a g i n g i n f l a m m a t i o n

Since inflammation is central to the pathogenesis

of asthma and has implications for the diagnosis,
management, and potential prevention of the
disease, it is vital to keep this inflammation
under control. As the standard focus of
treatment, antiinflammatory therapy with inhaled
corticosteroids (ICS) has been used based on
symptoms and measures of lung function.3

W h y m e a s u r e F e NO ?

While ICSs are highly effective in the treatment of

allergic airway inflammation, often the underlying
cause of asthma, symptoms and lung function are only
indirect measures of airway inflammation. Conversely,
FeNO is correlated with airway inflammation and the
potential for steroid responsiveness.1
SUMM A RY

In September 2011, the ATS published a clinical

practice guideline addressing improvements in
patient care when FeNO is used in clinical practice
as a part of asthma management.1

The guideline emphasizes the critical role of

underlying airway inflammation in asthma, but
it also points to considerable variability in the
patterns of inflammation, indicating phenotypic
differences that may influence treatment response.1

FeNO is now recognized as a simple, accessible

biomarker that can detect inflammation type,
thereby serving as a reliable clinical tool in the
diagnosis and management of asthma.1

To receive your copy of the 2011 ATS clinical practice

guideline, send an e-mail to

[email protected]
G u i d e l i n e Hi g h l i g h t s

Reasons to obtain an FeNO test1:

D I A GNOS I S
Diagnose eosinophilic airway inflammation
S upport the diagnosis of asthma when objective evidence
is needed
Assist in assessing the etiology of respiratory symptoms
Help identify the eosinophilic asthma phenotype
 ssess whether airway inflammation is contributing to
A
poor asthma control, particularly in the presence of
comorbidities or other contributors (eg, rhinosinusitis,
anxiety, gastroesophageal reflux, obesity, or continued
allergen exposure)
E stablish a baseline FeNO during clinical stability for
subsequent monitoring of chronic, persistent asthma

TRE A TMENT
 etermine the likelihood of an individual patient’s
D
response to antiinflammatory agents, including
corticosteroid treatment


Guide changes in dose of antiinflammatory medications:
step-down or step-up dosing or discontinuation of
antiinflammatory medications

MON I TOR I NG
 onitor airway inflammation compared with baseline in
M
patients with asthma

Account for persistent and/or high allergen exposure as a
factor associated with higher levels of FeNO

A DHERENCE
 ssist in the evaluation of adherence to antiinflammatory
A
medications, including corticosteroids
R e c o m m e n d at i o n s

The ATS Guideline Strongly Recommends1:

F eNO less than 25 ppb (<20 ppb in children)
indicates that eosinophilic inflammation and
responsiveness to corticosteroids are less likely
FeNO greater than 50 ppb (>35 ppb in children)
indicates that eosinophilic inflammation and,
in symptomatic patients, responsiveness to
corticosteroids are likely
F eNO values between 25 ppb and 50 ppb
(20-35 ppb in children) should be interpreted
cautiously and with reference to the clinical
context

According to the guideline,

conventional tests such as FEV1,
reversibility, and provocation
tests are only indirectly associated
with airway inflammation.1

References: 1. Dweik RA, Boggs PB, Erzurum SC, et al; on behalf of the
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. Am J Respir Crit Care Med. 2011;184:602-615. 2. National
Asthma Education and Prevention Program; National Heart, Lung, and Blood
Institute. Expert panel report 3: guidelines for the diagnosis and management
of asthma. Full report 2007. http://www.nhlbi.nih.gov/guidelines/asthma/
asthgdln.pdf. Published August 28, 2007. Accessed August 24, 2011.
3. Diseases and conditions index: asthma. National Heart, Lung, and Blood
Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_
WhatIs.html. Revised February 2011. Accessed August 24, 2011. 4. Data on
file, Aerocrine, Inc.
NIOX ®: The Gold Standard
in F e NO Measurement

Aerocrine is continuously developing and documenting FeNO

measurement as a valuable diagnostic tool in the management
of airway disease.

More than 4.5 million tests with the NIOX MINO prove that it
is the gold standard for FeNO testing.4

Continuous ground-breaking development

 erocrine developed the first instrument for the
A
measurement of exhaled NO
 erocrine has close collaboration with the world’s
A
leading FeNO scientists and clinicians
 erocrine will continue to lead the advancement of
A
FeNO as a marker of airway inflammation and a leading
valuable indicator of airway health

Important note: NIOX instruments are medical devices

regulated in the United States by the US Food and Drug
Administration. Complete Labeling for our devices may be
found at FDA.gov.
This cleared Labeling is the final authority
for Indications, Directions for Use, Risks,
Limitations, Performance, and other
information.
Consult our Labeling for any questions
you may have. You may also call
Aerocrine at 1-866-275-6469.

Aerocrine, Inc
562 Central Avenue
New Providence, NJ 07974
www.nioxmino.com
www.aerocrine.com

Aerocrine, NIOX MINO®, and NIOX® are registered trademarks of Aerocrine AB.
©2011 Aerocrine Inc