FeNO Testing in Primary Care

FeNO devices measure fractional exhaled nitric oxide (FeNO) in the breath of patients. Nitric oxide is a biomarker for asthma which provides an indication of the level of inflammation in the lungs.¹

The benefits of FeNO include improved accuracy of diagnosis for patients suspected of having asthma and it also helps both patients and clinicians understand the individual’s condition in more detail.¹ The most recent BTS/NICE/SIGN joint Asthma guidance [NG245], recommends that FeNO is performed as an objective test to help support a diagnosis of asthma.²

Despite this, in 2020, it was noted that FeNO testing had lower-than-expected patient access,³ this presents an opportunity for the NHS to improve uptake and support the NHS Long Term Plan ambition of improving early and accurate diagnosis of respiratory conditions by embedding FeNO testing in primary care.³

Senior Respiratory Specialist Nurse Lead Sonia Silk discusses why FeNO testing is needed in primary care; with reference to the use of FeNO within the asthma and severe asthma pathway. She also presents the practical tips (Do’s and Don’ts) and summarises how clinicians can incorporate FeNO testing into their day-to-day work. Please also consider watching the on-demand video ‘Why Fractional Exhaled Nitric Oxide (FeNO)?’ by Respiratory Consultant Dr Rory Chan, who outlines what FeNO testing is and shares data on the link between FeNO levels, exacerbation rates and lung function decline.

References

1. NHS England. Fractional Exhaled Nitric Oxide (FeNO). https://www.england.nhs.uk/aac/what-we-do/innovation-for-healthcare-inequalities-programme/rapid-uptake-products/fractional-exhaled-nitric-oxide/

2. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) https://www.nice.org.uk/guidance/ng245/resources/asthma-diagnosis-monitoring-and-chronic-asthma-management-bts-nice-sign-pdf-66143958279109

3. Health Innovation Wessex. FeNO Programme Impact. https://healthinnovationwessex.org.uk/projects/604/feno-programme-impact

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• Sonia Silk

  Senior Respiratory Specialist Nurse at Gloucester Inner City PCN

  Read biography
  Sonia Silk

  Senior Respiratory Specialist Nurse at Gloucester Inner City PCN Gloucestershire Integrated Care Board

  Role and Location
  Senior Respiratory Specialist Nurse at Gloucestershire Integrated Care Board.

  Education
  Sonia has worked in healthcare for over 30 years, and she trained at King’s College London University. Sonia felt drawn to humanitarian aid and worked in high conflict areas such as DRC, Albania, and Burundi. She studied Tropical Medicine at the London School of Hygiene & Tropical Medicine. This work functioned as a catalyst for Sonia’s interest in Public Health and upon returning to the UK she furthered her career in Primary Care, with an interest in respiratory. Sonia has been working as a respiratory specialist nurse across Gloucestershire since 2015.

  Research Interests
  Sonia is the Respiratory Champion for Gloucester Inner City PCN; a role that grew and included becoming the clinical lead on a large respiratory Quality Improvement Project. She won the ARNS award for ‘Respiratory Excellence’ in 2023. Sonia particularly enjoys the training and mentoring aspect of her work, especially inspiring colleagues to further their journey in respiratory care.