New Severe Asthma Guidelines Recommend FeNO Monitoring

Dr. Helen Reddel

In a significant advancement in the treatment of severe asthma, the latest diagnosis and management guide from the Global Initiative for Asthma (GINA) makes new recommendations for assessment tools.

The new guide now recommends fractional exhaled nitric oxide (FeNO) monitoring as an assessment tool to determine whether patients who are on high-dose inhaled corticosteroids or low-dose oral corticosteroids have residual inflammation.

In a statement accompanying the new guidelines, Dr. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, explained that difficult-to-treat and severe asthma are currently high priority due to their “physical, emotional and financial burden for patients and their families.”

“Clinicians in both low and high income countries need practical advice about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care,” Reddel said.

Utilizing FeNO measurements can provide a potential predictor of positive responses to anti-immunoglobulin E (anti-IgE) therapy for patients with severe, allergic asthma, and is a tool to identify refractory type 2 inflammation in patients on high-dose inhaled corticosteroids therapy.

“The new GINA guidelines build on an earlier US Agency for Healthcare Research and Quality (AHRQ) report in terms of the strength of FeNO as a practical tool that improves outcomes for asthma patients,” said David Acheson, Senior Vice President of US Commercial at Circassia Pharmaceuticals, Inc., a specialty pharmaceutical company focused on respiratory disease which announced the new recommendations on December 5.

“This GINA guide focuses on difficult-to-treat and severe asthma, which can be particularly devastating to patients and costly to the healthcare system in terms of physician visits, medication, hospitalization and management of treatment side effects,” Acheson said. “The strength of the guidance leaves no question about the role of NIOX (exhaled nitric oxide) in the successful diagnosis and management of asthma patients.”

Approximately 17% of asthma patients are considered difficult-to-treat, according to estimates from GINA, while approximately 3.7% of asthma patients are considered severe, in that asthma is uncontrolled despite adherence with maximal optimized therapy and treatment of contributory factors, or that worsens when high dose treatment is decreased, according to the release.

Type 2 inflammation is found in approximately half of people who have severe asthma, according to GINA.

The guide recommends repeating FeNO measurements up to 3 times in the event that a patients’ asthma worsens prior to determining whether it is non-type 2, according to a press release from Circassia.

FeNO monitoring is also recommended to assess adherences in patients with elevated type 2 biomarkers on high-dose inhaled corticosteroids prior to prescribing a biologic. Additionally, FeNO measurement is recommended as a method of monitoring tapering of oral corticosteroid treatment, according to the release.

Currently, Circassia’s FeNO by NIOX, which provides objective and accurate FeNO measurement of airway inflammation, is the only FeNO testing device in the US available at point-of-care, according to the release.

The guidelines, titled “Difficult-to-Treat & Severe Asthma in Adolescent and Adult Patients — Diagnosis and Management,” were published online on the GINA website.