New ATS guideline addresses use of FeNO to guide asthma treatment

Fractional exhaled nitric oxide testing is beneficial and is recommended in addition to usual care in patients with asthma being considered for treatment, according to a new clinical practice guideline from the American Thoracic Society.

“While our task was to review whether FeNO testing be performed when treatment is being considered, the studies being evaluated as well as the interpretation of the results via our methodology suggest that any patient with asthma may be eligible for the measurement of FeNO in decision-making regarding therapy,” guideline co-chairs Sumita B. Khatri, MD, MA, physician at the Asthma Center in the Cleveland Clinic’s Respiratory Institute, and Teal S. Hallstrand, MD, MPH, professor in the division of pulmonary, critical care and sleep medicine and the department of medicine at the Center for Lung Biology at the University of Washington, Seattle, said in a press release issued by the ATS. “As rigorous as our evaluation of the single question we were asked to investigate was, it should be noted that this guideline does not address the question of FeNO to establish the diagnosis of asthma or the utility of FeNO in monitoring asthma. We believe these issues that were identified by the panel as being important should be addressed in the future in a systematic manner.”

The recommendation in the guideline is as follows:

• In patients with asthma in whom treatment is being considered, use of fractional exhaled nitric oxide (FeNO) in addition to usual care is recommended over usual care alone (conditional recommendation, low confidence in estimates of effect).

The ATS issued a previous clinical practice guideline for the interpretation of FeNO in adults and children aged 4 years and older after the development of FeNO as a testing measurement in 2011. Since the initial guideline, several studies divided FeNO values into more narrowly defined ranges and confirmed the value of FeNO testing for multiple asthma outcome measurements, according to the release.

A number of key questions about FeNO remained, but based on several systematic reviews, the expert panel was asked to identify and address the most critical question that impacts patient care. The international, multidisciplinary expert panel conducted systematic reviews of published randomized controlled trials from 2004 to 2019 to develop the recommendations. The question that was chosen assesses the utility of the FeNO test in the management of individuals in whom treatment is being considered, according to the release.

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