Summary for Clinicians: Clinical Practice Guideline for the Use of Fractional Exhaled Nitric Oxide to Guide the Treatment of Asthma
A clinical practice guideline was developed by the American Thoracic Society (ATS) in 2011 regarding the interpretation of FeNO concentrations for clinical applications, but several key questions remained, including the use of this test in establishing a diagnosis of asthma, monitoring response to therapy, and for making individual treatment decisions in patients with known asthma.
Because of these knowledge gaps, the ATS convened a multidisciplinary panel of experts to identify a single most pressing question regarding the use of FeNO in clinical practice and develop an evidence-based guideline after a systematic review of the literature and meta-analysis or narrative review of relevant outcomes. Specifically, the committee members determined by consensus to address the highest priority question: should patients with asthma in whom treatment is being contemplated undergo FeNO testing?
This summary is intended to provide clinicians with the key take-home points from the clinical practice guideline, which have different implications for individual stakeholders.
Pulmonologists, critical care specialists, translational researchers, and clinicians.
After reading this journal article, learners will be able to:
- Identify the origin of fractional exhaled NO (FeNO).
- Describe the panel’s prioritization of individual outcome measures in making the conditional recommendation for implementation of FeNO testing in patients with asthma in whom treatment is being contemplated.
- Evaluate the results of the committee’s systematic review and subsequent meta-analysis by identifying outcome measures that were significantly improved with implementation of FeNO testing in addition to usual care over usual care alone.
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Ryan C. Murphy, (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Peng Zhang, (Cleveland Clinic, Cleveland, OH, USA) reported no relevant financial relationships.
Vickram Tejwani, (Cleveland Clinic, Cleveland, OH, USA) reported no relevant financial relationships.
Sumita B. Khatri, (Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA) reported no relevant financial relationships.
Teal S. Hallstrand, (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Joseph K. Ruminjo, (American Thoracic Society, New York, NY, USA) reported no relevant financial relationships.
Carey C. Thomson, (Mt. Auburn Hospital, Cambridge, MA, USA) reported no relevant financial relationships.
Off-Label Usage Disclosure
Disclosures of AnnalsATS CME Planners
The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.
AnnalsATS CME Planners
Alan M. Fein, M.D.
Podcast Editor, AnnalsATS
Dr. Fein reported that he has no financial relationships with commercial interests.
Constantine Manthous, M.D.
Associate Editor, AnnalsATS
Dr. Manthous reported that he has no financial relationships with commercial interests.
Gregory A. Schmidt, M.D.
Editorial Board, AnnalsATS
Dr. Schmidt reported payments for writing a textbook on critical care medicine (McGraw-Hill) and for writing contributions for UptoDate.
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