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Improving asthma prescribing: is FeNO the answer?
  1. Jo Congleton
  1. Respiratory Department, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
  1. Correspondence to Dr Jo Congleton, Brighton and Sussex University Hospitals NHS Trust, Worthing, BN11 2DH, UK; jo.congleton{at}

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Various prescribing measures for asthma suggest suboptimal control (eg, excess prescribing of short-acting beta2 agonist inhalers) and it is reported that the diagnosis of asthma is incorrect in up to one-third of patients.1 There is, therefore, a strong case to be made for using objective tests before starting or escalating asthma treatment. Measurement of fractional exhaled nitric oxide (FeNO) has been proposed as a quick, easy to perform, noninvasive, diagnostic tool. Raised FeNO levels indicate eosinophil airway inflammation and support a diagnosis of asthma.2

The National Institute for Health and Care Excellence (NICE) published evidence-based recommendations on FeNO in 2014 and included FeNO measurement in its diagnostic algorithms for asthma in 2017.2 3 Currently, FeNO devices cost around £3000 and the cost of a test varies depending on the number carried out each year but is estimated at £10 per test. NICE suggests that the use of …

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