Bosch Healthcare Solutions │ Vivatmo pro for medical professionals │ Studies and Evidence │ FeNO

Benefits of a FeNO-aligned therapy in pregnant asthmatics on the incidence of asthma in their children

Morten M et al. Managing Asthma in Pregnancy (MAP) trial: FENO levels and childhood asthma. J Allergy Clin Immunol 2018;142:1765-72.e4.

Study objective

To investigate the impact of FeNO-targeted asthma management during pregnancy on the unborn child in relation to the development of early childhood asthma.

Study findings

Frequency (%) of early childhood asthma diagnosis among pregnant asthmatic women

Study graph shows incidence of early childhood asthma in children of asthmatic pregnant women, FeNO monitoring can reduce risk from 43.2% to 25.9%. — Significant reduction in childhood asthma diagnosis with FeNO-aligned treatment compared to symptom-guided treatment during pregnancy.

Conclusion

Asthma treatment of pregnant asthmatics targeted according to symptoms and FeNO levels resulted in a significantly lower incidence of a preschool asthma diagnosis in their children (25.9% vs. 43.2%). This is partly due to changes in the use and dosage of inhaled corticosteroids during the MAP study.

Benefits of FeNO measurement over conventional tests in asthma diagnosis

Smith AD et al. Diagnosing asthma: comparisons between exhaled nitric oxide measurements and conventional tests. Am J Respir Crit Care Med. 2004; 169(4): 473-8.

Study objective

To evaluate the usefulness of various diagnostic tests (including peak-flow measurements, spirometry, FeNO measurement and induced sputum diagnosis) in confirming the diagnosis of asthma.

Study population

47 consecutive patients aged 8-75 years who were referred by their primary care physician to the pulmonary function laboratory at Dunedin Hospital (Dunedin, New Zealand) for assessment for possible bronchial asthma. No patients were referred for specialist consultation, and there was no prior selection of patients except that each test person had to have had respiratory symptoms for at least six weeks.

Study findings

Test sensitivities in comparison (%)

Chart graph showing test sensitivities of peak flow, sputum and FeNO, FeNO performs best at 88%. — The conventional tests showed a sensitivity between 0-47%. FeNO measurement as well as sputum eosinophils showed almost twice the sensitivity.

Conclusion

The study shows that FeNO measurements and induced sputum diagnostics produce more reliable results than conventional methods, with FeNO measurement offering a major advantage in terms of ease, speed and non-invasiveness of performance by comparison.

FeNO measurement: reliable detection of the degree of inflammation of the lungs

Bardsley G et al. Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomized controlled trial. Respiratory Research (2018) 19:133.

Background

In this study, the British pharmaceutical company GlaxoSmithKline compared the efficacy of new steroid spry with that of a conventional steroid spray. The objective of the study was to determine whether the new medication has a longer lasting anti-inflammatory effect. FeNO measurement and peak flow measurement were used to detect the degree of inflammation in the lungs.

Study findings

Graphic FeNO measurement — FeNO measurement provided more reliable evidence of the degree of inflammation in the lungs compared to peak flow measurement.

Conclusion

This study by the British pharmaceutical company GlaxoSmithKline on the efficacy of a new steroid spray shows that FeNO, as an inflammatory marker, was able to reliably detect the degree of inflammation in the lungs when the steroid was administered and discontinued, while peak flow measurement showed a high inaccuracy.

Measurement of FeNO value: comparison of three different commercial analysers

Korn S et al. Measurement of Fractional Exhaled Nitric Oxide: Comparison of Three Different Analysers. Respiration. 2020;99(1):1-8.

Study objective

The objective of this study was to compare the novel Vivatmo pro (Bosch) analyser device with NIOX VERO (Circassia) and CLD 88sp (Ecomedics).

Study findings

Difference plots in comparison

Study graph with difference plot evaluation for Vivatmo pro, CLS and NIOX Vero analyzer. — The study was conducted with 100 patients with asthma.

The difference plots showed agreement for all analysers within the predefined acceptance criterion of ±5 ppb within the clinically relevant range (0-70 ppb).

Conclusion

In the clinically relevant range between 0 and 70 ppb, the FeNO concentrations measured with all three devices were statistically equivalent within the predefined acceptance criteria and did not differ in a clinically relevant way. However, the highest success rate for obtaining two valid FeNO readings using the same device without failed attempts was achieved with the Vivatmo pro.