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Consider nitric oxide tests for asthma patients

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Nurses have been advised to consider using nitric oxide breath tests which could help prevent asthma attacks, in a new NICE technology assessment.

The advice has been backed by nurses who already use the method and believe that NICE's recommendations could lead to better diagnosis and treatment along with fewer asthma attacks and hospitalisations.

The new recommendations endorse tests to measure airway inflammation in patients with asthma, or those suspected to have the condition.

Senior nurse practitioner, Carol Stonham, who runs a respiratory clinic in Gloucestershire, said that measuring nitric oxide allows a more accurate reading in minutes. 'Now that NICE have considered the evidence for fractional exhaled nitric oxide (FeNo) and announced their recommendations, I hope this will give healthcare practitioners the confidence to use it more widely in primary care. FeNo has been a standard part of our asthma toolkit for some years now and it has enhanced the care we give to our patients.'

Beverly Bostock-Cox, a nurse practitioner, clinical lead for Education for Health and a guest lecturer at Imperial College London, said that the test was useful for two reasons. 'The first is that clinicians will be able to see the level of inflammation clearly. Secondly, it is important that patients are also able to see their levels of inflammation.'

'However, a problem with this tool is that it is quite expensive. It has an expiry date so would need to be used within that time, and the mouthpiece is also consumable and so is quite expensive. This will probably hold practices back from using it.'

'Nurses would also need to be trained to use this test. There is a specific technique required to administer this test correctly and effectively,' she added.

Ms Bostock-Cox recommended that CCGs look at the levels of hospital admissions due to asthma exacerbations which could have been prevented earlier by using this test and then decide whether introducing the test would be cost-effective.

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