December 2011

December 2011: Health Note - American Thoracic Society annouces New Guidelines - A Look at what it means for Asthma Care

Author: Thomas Beller, M.D.

The American Thoracic Society (ATS) recently released its official clinical practice guidelines, providing strong recommendations for measuring fractional exhaled nitric oxide (FENO) to determine airway inflammation in the diagnosis and treatment of asthma. The new guidelines will transform how more than 20 million Americans are tested for the disease which accounts for 217,000 emergency room visits, and 10.5 million doctor’s office visits every year.

FENO’s role in diagnosing asthma
FENO serves as a marker for airway inflammation, which is the underlying cause of asthma, inducing the recurring symptoms associated with the disease, including wheezing, shortness of breath, chest tightness and coughing. While traditional and widely used asthma testing, such as spirometry, is very effective in detecting airway obstruction, it leaves inflammation untested. Higher levels of FENO have been shown to have a significant correlation with the presence of eosinophilic airway inflammation; the most common type of airway inflammation is asthma, which also increases sensitivity to allergens.

What ATS guidelines mean for physicians and their patients
Measuring FENO levels in a patients’ breath can help determine the type of airway inflammation as well as:

• Confirm asthma in patients

• Determine whether patients with chronic respiratory symptoms will respond to corticosteroid treatment

• Monitor airway inflammation in current asthma patients to ensure the condition does not worsen.

By gaining an accurate measurement of FENO, physicians can better diagnose asthma and confidently recommend treatment procedures tailored to each individual case.

How to test for FENO
Currently, there is only one device on the market in the United States that offers physicians the ability to measure inflammation while analyzing FENO, all while the patient is in the office. The handheld test is very easy to use and only requires a single breath of 10 seconds. This device, NIOX MINO, also makes it possible for physicians to obtain a more accurate reading of patient adherence to current treatment plans and manage their asthma on a truly personalized basis.

This device helps to predict exacerbations and, most importantly, helps to prevent them. It also affords physicians the ability to change prescriptions and tweak dosage schedules in order to keep FENO and inflammation levels manageable. In addition, by predicting and avoiding asthma exacerbations, patients have been less likely to accrue emergency medical costs.

Up until now, airway inflammation testing methods—including biopsy, bronchoalveolar lavage techniques and sputum analysis—have not been used in physician offices due to cost and the fact that they are far too invasive and time-consuming in most cases. NIOX MINO is a compact, inexpensive, handheld device that is easy to operate and provides results in less than two minutes. This new technology can help physicians adhere to the new ATS guidelines and, in turn, help patients live a life that is less affected by asthma symptoms.

Each case of asthma is unique and requires a unique course of treatment. There is no universal cause, and therefore, there is no universal solution. However, by monitoring FENO, physicians specializing in asthma may be able to further optimize treatments individually for patients, improving their quality of life and decreasing asthma’s physical and economic burden.

Thomas Beller, M.D. is board certified in internal medicine and allergy & immunology. He currently practices at the Allergy and Asthma Center of Hilton Head. For more information, visit

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