I went to a lecture recently and heard Dr. Chipps, a very distinguished asthma and allergy physician from Sacramento, CA. While most of us are familiar with the use of inhaled nitric oxide (NO) for PPHN, NO can also be used as a biologic marker in asthma. Nitric oxide is a naturally produced substance in our bodies and measuring the fractional exhaled nitric oxide (FeNO) can be used to suggest lung inflammation. The results are combined with eosinophil results (blood test) to get a more accurate clinical picture.

The NIOX device is about the size of a bedside spirometer and is very easy to use. The FeNO test is faster, cheaper, and safer than a methacholine challenge test. FeNO results have been proven to be a better indicator for the administration of inhaled steroids than patient history alone. FeNO can also help R/O other diagnoses, such as VCD.

What does this mean to you? You probably won’t use it in the ER, but might find one in the PFT lab, outpatient clinic, or doctor’s office. According to Dr. Chipps, national refill rates of inhalers are about 2-4 times per year. These are only good for 30 days, so the refill rate should be 12 per year. Using FeNO can tell you how compliant your patients are, which could help decrease readmission rates.