Update on the Role of FeNO in Asthma Management

Abstract

Asthma is a heterogenous disorder characterized by presence of different phenotypes and endotypes. Up to 10% of the individuals suffer from severe asthma and are at increased risk of morbidity and mortality. Fractional exhaled nitric oxide (FeNO) is a cost-effective, point of care biomarker that is used to detect type 2 airway inflammation. Guidelines have proposed to measure FeNO as an adjunct to diagnostic evaluation in individuals with suspected asthma and to monitor airway inflammation. FeNO has lower sensitivity, suggesting that it may not be a good biomarker to rule out asthma. FeNO may also be used to predict response to inhaled corticosteroids, predict adherence and deciding on biologic therapy. Higher levels of FeNO have been associated with lower lung function and increased risk for future asthma exacerbations and its predictive value increases when combined with other standard measurements of asthma assessment.

Fractured Exhaled Nitric Oxide and Biologic Therapies for Paediatric Asthma

“…This dual mechanism inhibits the action of both pro-inflammatory cytokines in patients with T2-positive asthma. Dupilumab is indicated for patients aged 6 years and older with allergic and non-allergic eosinophilic asthma with FENO > 25 ppb, who depend on oral corticosteroids to control their symptoms, regardless of the blood eosinophil count (50). The role of FENO as a predictor of a good therapeutic response was confirmed in the Liberty Asthma Quest trial (NCT02414854).…”

Inhaled nitric oxide: can it serve as a savior for COVID-19 and related respiratory and cardiovascular diseases?

“…The COVID-19 pandemic has placed a significant burden on healthcare systems around the world, and the rational allocation and utilization of healthcare resources and the economy in response to the severity of the disease is an urgent issue, so researchers are looking for a convenient, safe, and non-invasive biomarker to stratify the risk level of the disease. Fraction of exhaled nitric oxide (FeNO) is a simple, reproducible, non-invasive biomarker with diagnostic value for nonspecific respiratory symptoms and airway inflammation and is used as an adjunctive assessment for the diagnosis of asthma, predicting the response to inhaled corticosteroids, and guiding clinical treatment ( Guida et al, 2023 ; Murugesan et al, 2023 ). FeNO levels in COVID-19 patients and the clinical value of FeNO in COVID-19 are controversial.…”

Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs

“…Type 2 (T2) airway responses are primarily mediated by eosinophils, basophils, and mast cells [39,40]. T2 helper T cells and T2 innate lymphoid cells, along with cytokines, including IL-4, IL-5, and IL13, play a role in its pathogenesis.…”

“…Fractional exhaled nitric oxide (FeNO) is a biomarker of type 2 airway inflammation [40]. It has been shown to correlate with lung function and future exacerbations and predict the response to treatment in patients with asthma [40].…”