NICE has issued final guidance recommending the use of a simple test to help clinicians in the diagnosis and management of asthma. People with asthma often have inflamed lungs and breathe out higher levels of nitric oxide. In the new guidance, NICE recommends 3 devices to measure the levels of nitric oxide a person is breathing out. They are NIOX MINO and NIOX VERO (Aerocrine), and NObreath (Bedfont Scientific Ltd).

The guidance recommends nitric oxide testing as an option in diagnosing suspected cases of asthma. But it says other tests are needed to confirm the diagnosis as recommended by the British guideline on the management of asthmaⁱ. 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. People with asthma develop inflamed airways. The symptoms, which include shortness of breath, a tight chest, wheezing or coughing, can be controlled with drugs called corticosteroids.

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “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% of people do not take their medication to control their asthma).

Professor Longson added: “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 arerecommended by the British guideline on the management of asthma.”

“The Committee heard from a patient expert that managing asthma through measurement of nitric oxide could result in the patients better understanding their own disease and disease progression, and make them more willing to accept the need for anti-inflammatory treatment to control their asthma.”

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. The Committee concluded that, based on the available evidence, nitric oxide testing is useful in the management of asthma in people who still have symptoms despite being treated with inhaled corticosteroids, and could reduce asthma attacks. Nitric oxide could also be a useful marker to show whether patients are using their medicines correctly and if not to help them better manage 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 available on the NICE website, to help centres that may want to use the devices in the future.

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

About the guidance

1. The guidance on nitric oxide tests to help diagnose and treat asthma is available on the NICE website.

About asthma

2. Asthma is a chronic condition affecting the airways, caused primarily by inflammatory processes and constriction of the smooth muscle in airway walls (bronchoconstriction).

3. Asthma is characterised by airflow obstruction and increased responsiveness of the airways to various stimuli. Symptoms include recurring episodes of wheezing, breathlessness, chest tightness and coughing. Typical asthma symptoms tend to be variable, intermittent and worse at night.

4. Asthma is commonly triggered by viral respiratory infections, exercise, or external factors, such as smoke, a change in weather conditions and allergens, for instance pollen, mould and house dust mite.

5. Asthma usually develops in childhood but may start at any age. There is no cure for asthma, although people may experience long periods of remission. Poorly controlled asthma can have a significant impact on the quality of life of the affected person and their family.

6. The British Guideline on the Management of Asthma (2012) available from the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) provide the current guidelines on the diagnosis, monitoring and management of asthma in both adults and children.

7. Asthma is diagnosed on the basis of symptoms and objective tests of lung function. Spirometry is a method of assessing lung function by measuring the volume of air that the patient is able to expel from the lungs after a maximal inspiration.

8. 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. There are around 1000 deaths a year from asthma, about 90% of which are associated with preventable factors. Almost 40% of these deaths are in people under 75. Asthma is responsible for large numbers of accident and emergency department attendances and hospital admissions. Most admissions are emergencies and 70% may have been preventable with appropriate early interventions.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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