New Severe Asthma Guidelines Recommend FeNO Monitoring

If your patients end up on high dose asthma therapy or have frequent exacerbations, reassessment is needed.  Exhaled nitric oxide testing provides a method for non-invasive point of care assessment for asthma and asthma control and can help direct therapy for severe asthma.  The latest iteration of GINA guidelines acknowledges this. Dr. Susarla

In a significant advancement in the treatment of severe asthma, the latest diagnosis and management guide from the Global Initiative for Asthma (GINA) makes new recommendations for assessment tools.

The new guide now recommends fractional exhaled nitric oxide (FeNO) monitoring as an assessment tool to determine whether patients who are on high-dose inhaled corticosteroids or low-dose oral corticosteroids have residual inflammation.

In a statement accompanying the new guidelines, Dr. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, explained that difficult-to-treat and severe asthma are currently high priority due to their “physical, emotional and financial burden for patients and their families.”

 “Clinicians in both low and high income countries need practical advice about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care,” Reddel said.

Utilizing FeNO measurements can provide a potential predictor of positive responses to anti-immunoglobulin E (anti-IgE) therapy for patients with severe, allergic asthma, and is a tool to identify refractory type 2 inflammation in patients on high-dose inhaled corticosteroids therapy.

“The new GINA guidelines build on an earlier US Agency for Healthcare Research and Quality (AHRQ) report in terms of the strength of FeNO as a practical tool that improves outcomes for asthma patients,” said David Acheson, Senior Vice President of US Commercial at Circassia Pharmaceuticals, Inc., a specialty pharmaceutical company focused on respiratory disease which announced the new recommendations on December 5.

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Impulse Oscillometry: From Bench to Clinical Practice.

Impulse Oscillometry: From Bench to Clinical Practice.

Lung function testing is one of the pillars of care in childhood asthma.  There are few substitutes to actually measuring the way the lungs perform in an objective way.  However, testing in children is often very difficult to perform, making interpretation of the results even more difficult.

Airway resistance testing as performed using a technique known as impulse oscillometry (IOS) offers a convenient alternative.  This test takes seconds to perform and allows us to measure the reactivity in a child's airway WITHOUT forceful breathing maneuvers or breath holding.  These data are invaluable in diagnosing asthma especially in young children down to 3 years of age. In addition, it has been shown to help predict risk of exacerbations in children with known asthma.

One of the many benefits of care in a pediatric pulmonology office is focus on the latest and greatest diagnostic testing.  What was previously only a research tool is now available as a state-of-the-art test available in the clinic.  Ask about our impulse oscillometry testing in our Frostwood location.

From Vyaire Medical