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The Use of Fraction of Exhaled Nitric Oxide in Pulmonary Practice^*

^* From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic Foundation, Rochester, MN.

Correspondence to: Kaiser G. Lim, MD, FCCP, 200 First St SW, Rochester, MN 55905; e-mail: lim.kaiser{at}mayo.edu

Abstract

The measurement of the fractional concentration of exhaled nitric oxide (FeNO) is a convenient, noninvasive, point-of-service office test for airway inflammation. The first half of this practice management review presents the methodological, interpretative, and clinical applications of FeNO. The second half discusses practical management issues, including current and future technology, equipment specifications, US Food and Drug Administration regulations, cost, current procedural terminology coding, and reimbursement. The measurement of FeNO is helpful in the diagnosis of asthma. It is predictive of a response to inhaled corticosteroids (ICSs). Monitoring FeNO is useful in maintaining asthma control by allowing the assessment of adherence to medication and dose titration of ICSs. An elevated level of FeNO is predictive of asthma relapse following corticosteroid withdrawal especially in children. The advances in technology, ease of use, and clinical utility will lead to greater availability, acceptance, and routine application in the care of asthma.

Key Words: asthma • exhaled nitric oxide • practice management