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A quick, easy test helps us diagnose and control asthma in patients

Urban Health Plan is among the first medical institutions to measure fractional exhaled nitric oxide (FeNO), a biomarker for airway inflammation that helps us manage our patients with asthma. This simple test to measure FeNO plays a vital role in helping us diagnose and control asthma in our patients in the South Bronx-an area with one of the highest incidences of asthma-so they stay out of the hospital and emergency room.

Case in point: We manage 11,411 patients with asthma and only 4.3 percent have had an urgent care or emergency room visit within the past six months.

To measure FeNO, we use Aerocrine’s NIOX MINO and its next-generation NIOX VERO device across all of our sites. We’re especially excited about NIOX VERO, because it’s very simple to use and-best of all-it’s portable.

Many patients have symptoms of asthma but were never diagnosed with it because providers are afraid of labeling patients without some concrete measurement. In the past, the only objective test we could use to diagnose asthma was spirometry, a test used to assess how well patients’ lungs work by measuring how much air they inhale and exhale, as well as how quickly they exhale. It requires a trained clinician to provide the patient with specific instructions, and even then, it can be difficult for the patient to perform the test correctly.

The NIOX devices for testing FeNO are much easier and more beneficial to use in our medical practice than spirometry. I don’t need to train a respiratory therapist to perform the FeNO measurement test, and since the NIOX VERO device is so small and light, we can easily move it from exam room to exam room. That means our medical assistants can quickly test patients at the point of care.

Plus, it’s simpler to interpret the results than it is with spirometry. The FeNO measurement test for asthma is like the hemoglobin A1c test for diabetes: You have a number that you can use to help with diagnosis as well as a benchmark that you can share with patients as a way to demonstrate whether their asthma is improving.

For example, I use the NIOX device tests to monitor whether my patients are using their inhaled corticosteroid (ICS). One case that stands out was a 14-year-old patient. When I asked how her asthma was, she replied that it was good. She also told me that she was using her ICS as directed. After further questioning, however, I learned that she tried not to be too active in gym class, because it would make her cough. I explained to her that indicated her asthma was not well controlled, but she wasn’t convinced until I showed her the FeNO measurement, which was 62, and described what that number meant. Then she finally admitted that she hadn’t used her ICS in two weeks because she “felt good.”

As a result of seeing her test result, she began using her ICS again and two weeks later, when we did the test again, her FeNO number had dropped by 18 points. This measurable progress helped me convince her of the importance of using her ICS daily. She’s one of many noncompliant patients who became compliant because of the NIOX device test.

The NIOX devices also helps me identify patients with continuously high FeNO. With this information, I can get those patients on a short course of an oral steroid to reduce their airway inflammation, which can help prevent an uncontrolled asthma episode and a potential emergency department visit.

These are just a few examples of how the NIOX devices have helped us improve patient outcomes. Because the NIOX VERO device is so much easier to use and more mobile than the spirometer test, I’d love to see it take the place of spirometry as the gold standard for diagnosing and managing asthma.

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