To consider how and when we use FeNO testing, we need to go to the definition of asthma. Both BTS/SIGN1 and GINA2 define it as a predominantly inflammatory disorder of the airways with airway hyperresponsiveness and variability in symptoms. Nitric oxide is a gas involved in the respiratory process and is present in the atmosphere in very small amounts (parts per billion). It can be easily measured in exhaled breath using a fractional exhaled nitric oxide (FeNO) test.
Asthma is a long-term condition characterised for the vast majority by trigger induced eosinophilic airway inflammation resulting in wheeze, breathlessness, cough, and chest tightness. Before embarking on any treatment for asthma, it is essential to ensure that you, as the prescriber, can describe to the person with asthma:
According to the Global Initiative for Asthma (GINA) asthma control is assessed in two domains: symptom control and risk of adverse outcomes. Poor symptom control is budensome to patients and increases the risk of exacerbations, but patients with good symptom control can still have severe exacerbations.[1]
Resources from the Academic Health Science Network (AHSN) Programme
This pragmatic guide on the identification, referral and ongoing management of adults and children with severe asthma has been developed by an expert group led by Dr Steve Holmes, a GP based in Shepton Mallet, Somerset and including Will Carroll, University Hospital of the North Midlands, Stoke-on-Trent, Fiona Mosgrove, Clinical Lead Grampian Respiratory Improvement Programme, Angela Pugh of the University Hospital of Llandough Cardiff & Vale University Health Board and Robert Stone, Taunton and Somerset NHS Foundation Trust.
The asthma slide rule helps to start a conversation with your patients and colleagues around how much salbutamol is acceptable before a review is necessary
A common problem, not to be sneezed at! Allergic Rhinitis is often under recognised and poorly managed.
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