Is my patient taking their medication?
Is my patient at risk for an exacerbation?
Biomarkers we measure
Fractional exhaled nitric oxide (FeNO), a biomarker of Th2 inflammation. FeNO was added to the 2017 Global Initiative for Asthma (GINA) guidelines as an independent marker of exacerbation risk regardless of symptoms in allergic asthma.1-4 It is also recommended to identify eosinophilic airway inflammation in asthma/COPD overlap.1 Combining breath and blood biomarkers (FeNO, blood eosinophils, serum periostin, IgE) enhances the ability to predict exacerbations and identify therapeutic response.4,5
40% fewer exacerbations
FeNO in clinical practice
Using FeNO to guide therapy adjustments can reduce both the number and frequency of exacerbations by 40% versus guideline based care alone.6,7 FeNO can also be used to test for non-adherence. The biomarker is directly suppressed by inhaled corticosteroids within one day of adherence and rises within one day of non-adherence.8-10 FeNO is increased by prolonged allergen exposure.11
Objectively determine adherence before stepping up therapy
Perform baseline FeNO test in office. Additional tests ship to patients home.
Patient performs FeNO breath test and records inhaler usage in the app for 7 consecutive days at home.
Identify non-adherence and inflammatory phenotype with a single test.
FeNO is directly reduced by inhaled steroids within 1 day with a maximum effect occurring between 5 and 7 days. Our software confirms short term adherence and proper inhaler technique from the recorded videos. If the biomarker is reduced over seven days, the test is positive and confirms non-adherence. The test result and absolute biomarker levels will help determine whether to increase the dose or change the medication.
Monitor Risk of Exacerbation
Personalize therapy and prevent attacks
Patient performs FeNO test at home twice per month. Blood tests may also be ordered to add multiple biomarkers to our risk algorithms.
Monitor & Alert
Our software and clinical staff monitors risk of exacerbation based on the trend and absolute FeNO value. Both patient and physician are alerted when there is a change in risk.
The data is used to determine if a change in medication or dose is necessary to reduce the risk and prevent an attack.
Find the right medication and dose based on the underlying biology and exacerbation risk, not just symptoms. Tailoring therapy based on FeNO can reduce both the number and frequency of exacerbations by 40% versus guideline based management alone.6,7 FeNO indicates risk of exacerbation regardless of symptoms in allergic asthma patients.1,2 The biomarker will increase when patients are exposed to triggers, such as allergens. It is reduced by inhaled steroids and biological therapies targeting IgE, IL-4, and IL-13. The FeNO trend is also used to monitor changes in adherence.
Analytical and clinical performance data
- Global Initiative For Asthma. 2017 Global Initiative for Asthma Report: Global Strategy for Asthma Management and Prevention. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed April 4, 2017.
- Zeiger RS. Elevated exhaled nitric oxide is a clinical indicator of future uncontrolled asthma in asthmatic patients on inhaled corticosteroids. J Allergy Clin Immunol. 2011;128:412-414. doi:10.1016/j.jaci.2011.06.008.
- Zeiger RS. Association of exhaled nitric oxide to asthma burden in asthmatics on inhaled corticosteroids. J Asthma. 2011;48(1):8-17. doi:10.3109/02770903.2010.539295.
- Malinovschi A. Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects. J Allergy Clin Immunol. 2013;132(4). doi:10.1016/j.jaci.2013.06.007.
- Hanania NA. Exploring the Effects of Omalizumab in Allergic Asthma. Am J Respir Crit Care Med. 2013;187(8):804-811. doi:10.1164/rccm.201208-1414OC.
- Petsky HL. Exhaled nitric oxide levels to guide treatment for adults with asthma. In: Petsky HL, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2016. doi:10.1002/14651858.CD011440.pub2.
- Petsky HL. Exhaled nitric oxide levels to guide treatment for children with asthma. In: Petsky HL, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2016. doi:10.1002/14651858.CD011439.pub2.
- Hetherington K. Fractional exhaled nitric oxide (feno) suppression to identify non-adherence in difficult asthma. Thorax. 2016;71(Suppl 3):A4.2-A5. doi:10.1136/thoraxjnl-2016-209333.8.
- McNicholl DM. The utility of fractional exhaled nitric oxide suppression in the identification of nonadherence in difficult asthma. Am J Respir Crit Care Med. 2012;186(11):1102-1108. doi:10.1164/rccm.201204-0587OC.
- Martinez FD. Use of beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA): A randomised, double-blind, placebo-controlled trial. Lancet. 2011;377(9766):650-657. doi:10.1016/S0140-6736(10)62145-9.
- Dweik RA. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med. 2011;184(5):602-615. doi:10.1164/rccm.9120-11ST.