The West of England AHSN has been supporting several projects to implement FeNO testing in primary care. FeNO (fractional exhaled nitric oxide) is a point of care test to measure type two inflammation in airways, which augments and supports the accuracy of asthma diagnosis. The test aims to improve patient care and outcomes by more effective diagnosis of asthma. The AHSN has been working to improve the use of FeNO testing as part of the Rapid Uptake Product Programme.
To illustrate how FeNO testing has been used to improve diagnosis of asthma in the West of England; reduce referrals to secondary care and improve patient care, we’ve been working with primary care clinicians to capture some brief patient stories:
Patient story one: Female, aged 50
The patient came into the practice with shortness of breath and complaining of tightness in her chest. She had previously been prescribed an inhaled steroid by the GP but was reluctant to take this.
A FeNO test was performed and the result was 91 (NICE guidance: 2017, regards a positive FeNO level of 40), which suggested probable asthma. This prompted a discussion around the high result and the importance of trialling an inhaled steroid. The patient agreed to do so following her understanding of the FeNO result.
The patient was reviewed 4 weeks later and a further FeNO test was performed with a result of 36. She was happy with the improvement and felt this confirmed she had asthma and was responding to the prescribed treatment.
Patient story two: Male, 51
The patient came into the practice with suspected asthma. His symptoms included shortness of breath and a cough, particularly at night. He had already been prescribed an inhaled steroid by the GP when spirometry, another test used to help diagnose lung conditions, was unavailable due to Covid-19.
A FeNO test was performed and the patient’s result was 42 (NICE guidance: 2017, regards a positive FeNO level of 40), which suggested probable asthma. He was started on combination inhaled therapy of a LABA (long-acting bronchodilator inhaler) and ICS (inhaled corticosteroids).
The patient was reviewed 4 weeks later and a further FeNO test was performed with a result of 27, confirming that the prescribed therapy has relieved his symptoms. The patient felt that this confirmed he had asthma.
Whilst these stories present real case studies, names have been omitted to protect anonymity.
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