Current evidence and future research needs for FeNO measurement in respiratory diseases

Leif Bjermer, Kjell Alving, Zuzana Diamant, Helgo Magnussen, Ian Pavord, Giorgio Piacentini, David Price, Nicolas Roche, Joaquin Sastre, Mike Thomas, Omar Usmani

Research output: Contribution to journalArticlepeer-review

162 Citations (Scopus)
22 Downloads (Pure)


Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.

Original languageEnglish
Pages (from-to)830-841
Number of pages12
JournalRespiratory Medicine
Issue number6
Early online date15 Feb 2014
Publication statusPublished - Jun 2014

Bibliographical note

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.


  • breath test
  • diagnosis
  • therapy monitoring
  • health economy
  • eosinophil


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