Exhaled Nitric Oxide Measurement in Asthma Management
Summary
Exhaled nitric oxide measurement has emerged as a non-invasive biomarker for assessing eosinophilic airway inflammation in asthma. By quantifying fractional exhaled nitric oxide (FeNO) at defined expiratory flows, clinicians can infer the degree of type 2 immune activity within the bronchial mucosa. Elevated FeNO concentrations generally reflect upregulated inducible nitric oxide synthase (iNOS) in airway epithelial cells driven by interleukin-4 and interleukin-13. Integration of FeNO measurement into routine care has enabled personalised adjustment of inhaled corticosteroid dosing, identification of patients likely to respond to anti-type 2 biologics, and prediction of exacerbation risk. Standardisation of sampling protocols and awareness of confounding factors—such as atopy, smoking status, age and environmental exposures—are essential to ensure reproducibility. Recent technological advances have led to portable analysers that facilitate use in primary care and community settings. Overall, FeNO serves as a practical, point-of-care tool that complements spirometry and symptom assessment in guiding anti-inflammatory therapy and improving long-term asthma control.
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Exhaled Nitric Oxide Measurement in Asthma Management publication trend
The graph below shows the total number of articles in exhaled nitric oxide measurement in asthma management across all publications each year (not limited to Nature Index journals).
Technical terms
Fractional exhaled nitric oxide (FeNO): The concentration of nitric oxide in a fixed-flow exhalation, indicating airway inflammation.
Inducible nitric oxide synthase (iNOS): An enzyme upregulated by type 2 cytokines that catalyses nitric oxide production in airway epithelial cells.
T helper 2 (Th2) cells: A subset of lymphocytes that secrete interleukins 4, 5 and 13, driving eosinophilic inflammation in asthma.
Airway eosinophilia: Accumulation of eosinophil white cells in bronchial tissues, often reflected by elevated FeNO.
References
- Current evidence and future research needs for FeNO measurement in respiratory diseases. Respiratory Medicine (2014).
- Elevated Exhaled Nitric Oxide in Allergen-Provoked Asthma Is Associated with Airway Epithelial iNOS. PLOS ONE (2014).
- Exhaled Nitric Oxide as Biomarker of Type 2 Diseases. Cells (2023).
- Fractional exhaled nitric oxide (FeNO) among elementary school children in Stockholm: Associations with asthma, allergies, and home and school environment. The Science of The Total Environment (2025).
- The association of exhaled nitric oxide with air pollutants in young infants of asthmatic mothers. Environmental Health (2023).
- Performance of a new hand-held device for exhaled nitric oxide measurement in adults and children. Respiratory Research (2006).
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