PCRS Position Statement: Fractional exhaled nitric oxide (FeNO) and its role in diagnosis of asthma in primary care

The new BTS/NICE/SIGN guideline, Asthma: Diagnosis, monitoring and chronic asthma management (NG245) has placed fractional exhaled nitric oxide (FeNO) early in the diagnostic algorithm, which has caused some concern. Many healthcare settings do not have access to FeNO and are not therefore familiar with its use. It also has cost implications for healthcare commissioners across the UK, at a time when they have been asked to reduce running costs. 

It is therefore important that, whilst the use of FeNO becomes embedded in everyday practice, a pragmatic and resource sharing approach is considered. 

This PCRS position statement aims to address these issues and advocates that:

• Clinicians making a new diagnosis of asthma should be trained to do so and maintain their continued professional development (CPD) (PCRS Fit to Care).
• A pragmatic approach is taken to reduce the cost and training implications of the new BTS/NICE/SIGN asthma guideline and recommended use of FeNO in the diagnostic pathway.
• Novel ways of funding access to FeNO are explored by healthcare commissioners.
• Where Clinical Diagnostic Centres (CDCs)/Clinical Investigation Hubs (CIH) are available, a referral pathway for asthma diagnosis should be implemented with prompt and easy access for primary care.
• Primary Care Networks (PCNs) and Health Boards should be encouraged to pool resources and expertise and establish diagnostic hubs to ensure patients are seen quickly by an expert with access to all necessary diagnostic tools and close to home.