Domiciliary fractional exhaled nitric oxide and spirometry in monitoring asthma control and exacerbations

Ran Wang, Omar S Usmani, Kian Fan Chung, Jacob Sont, Andrew Simpson, Matteo Bonini, Persijn J Honkoop, Stephen J Fowler

Research output: Contribution to journalArticlepeer-review


Background: Domiciliary measurements of airflow obstruction and inflammation may assist healthcare teams and patients in determining asthma control and facilitate self-management. Objective: To evaluate parameters derived from domiciliary spirometry and fractional exhaled nitric oxide (FENO) in monitoring asthma exacerbations and control. Methods: Patients with asthma were provided with hand-held spirometry and FENO devices in addition to their usual asthma care. Patients were instructed to perform twice-daily measurements for 1 month. Daily symptoms and medication change were reported through a mobile health system. The Asthma Control Questionnaire was completed at the end of the monitoring period. Results: One hundred patients had spirometry, of which 60 were given additional FENO devices. Compliance rates for twice-daily measurements were poor (median [interquartile range], 43% [25%-62%] for spirometry; 30% [3%-48%] for FENO); at least 15% of patients took little or no spirometry measurements and 40% rarely measured FENO. The coefficient of variation (CV) values in FEV 1 and FENO were higher, and the mean % personal best FEV 1 lower in those who had major exacerbations compared with those without (P < .05). FENO CV and FEV 1 CV were associated with asthma exacerbation during the monitoring period (area under the receiver-operating characteristic curve, 0.79 and 0.74, respectively). Higher FENO CV also predicted poorer asthma control (area under the receiver-operating characteristic curve, 0.71) at the end of the monitoring period. Conclusions: Compliance with domiciliary spirometry and FENO varied widely among patients even in the setting of a research study. However, despite significant missing data, FENO and FEV 1 were associated with asthma exacerbations and control, making these measurements potentially clinically valuable if used.

Original languageEnglish
JournalThe journal of allergy and clinical immunology. In practice
Issue number6
Publication statusPublished - 18 Feb 2023


  • Adult asthma
  • Home monitoring
  • Asthma management
  • Monitoring
  • Asthma
  • Humans
  • Lung
  • Breath Tests
  • Asthma/drug therapy
  • Exhalation
  • Nitric Oxide
  • Fractional Exhaled Nitric Oxide Testing


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