National Institute for Health and Clinical Excellence (NICE)
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Simple test to help diagnose and manage asthma

A simple test that measures the levels of nitric oxide a person is breathing out to help with the diagnosis and management of asthma has been given the green light by NICE.

NICE recommends three devices - NIOX MINO and NIOX VERO (Aerocrine), and NObreath (Bedfont Scientific Ltd) - to measure nitric oxide levels which are raised in people with asthma.

In the UK, 5.4 million people are estimated to have asthma - the third highest prevalence in the world - 1.1 million of whom are children. Asthma is the most common long-term medical condition, and 1 in 11 children has it.

NICE recommends nitric oxide testing as an option in diagnosing suspected cases of asthma, but other tests are needed to confirm the diagnosis as recommended by the British guideline on the management of asthma.

Nitric oxide testing is also recommended as an option to support the management of asthma in people who still have symptoms despite being treated with inhaled corticosteroids.

Measurement of nitric oxide, used alongside other diagnostic options, may also help patients find the most appropriate medication earlier and manage their symptoms better. This could help avoid admissions to hospital caused by asthma attacks and improve patient experience.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “Diagnosing asthma is often a very complicated and lengthy process. Using these devices can provide additional information for clinicians about those people who, following clinical examination, are considered to have an intermediate probability of having asthma.

“But diagnosis is not straightforward because it is based on both symptoms and response to treatment. The independent experts who developed the guidance decided that nitric oxide testing should be used in combination with other diagnostic options that are recommended by the British guideline on the management of asthma.”

Professor Longson added: “People with some types of asthma have higher levels of nitric oxide in the air they breathe out. Treatment with corticosteroids helps to treat the symptoms of asthma and reduces the level of nitric oxide in breath.

“In people already diagnosed with asthma, measuring nitric oxide levels to guide their asthma management is likely to reduce asthma attacks. The measurements can reveal whether they are taking their medication as prescribed. Research suggests that as many as 30 per cent of people do not take their medication to control their asthma.”

As part of the guidance development, NICE has been working with a number of hospitals and GP surgeries across England to share their experience of using the technology. This practical information and advice has been summarised in a pack to help centres that may want to use the devices in the future.

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