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PCRS issues Pragmatic Advice on FeNO testing

If you are confused by conflicting guidance on the role of FeNO testing in the diagnosis of asthma, take a look at the new PCRS consensus statement which gives pragmatic advice on when FeNO testing in primary care should be considered.

The article reviews the new NICE and BTS/SIGN clinical guideline recommendations on the issue. It also explores the benefits, limitations and challenges of using this test in the primary care setting.

The article concludes that:

  • FeNO testing is a quantitative, non-invasive, simple and safe test making it suitable for use in the primary care setting when conducted by an appropriately trained health care professional competent to deliver and interpret the results. 
  • The benefits of FeNO testing in primary care are:
    • Patients don’t have to be referred to secondary care for additional testing. 
    • A positive FeNO test when considered alongside respiratory symptoms and lung function tests suggestive of asthma, supports a diagnosis.
  • But there are concerns about the necessity for FeNO testing in primary care for every asthma diagnosis and about its cost-effectiveness.  It may be more appropriate for FeNO testing to be carried out in diagnostic centres in the community, intermediate or secondary care setting.
  • Given the limitations of extending FeNO testing to all patients presenting with symptoms suggestive of asthma, the current PCRS position aligns with the guidance issued by BTS/SIGN. This is that the FeNO test should be used as an optional investigation to test for eosinophilic inflammation when there is diagnostic uncertainty.

Carol Stonham, Respiratory Nurse Practitioner and PCRS Executive Chair Elect, who co-authored the statement with Noel Baxter, GP and PCRS Executive Chair, says: “The use and placement of FeNO testing in asthma diagnosis is one of the areas where BTS/SIGN and NICE give conflicting advice. So PCRS have looked at the evidence and differing guideline recommendations for this consensus statement.  It offers clarity and pragmatic advice on when FeNO testing should be considered.”

This statement on the use of FeNO testing complements Asthma Guidelines in Practice, a PCRS consensus statement which clarifies conflicting national guidelines on the diagnosis, management and monitoring of asthma.  

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