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Resources at a glance

Programme(s):
FeNO - Fractional exhaled nitric oxide - for the diagnosis and management of Asthma

For rapid access to all resources available within these pages you can download and print out our Summary QR Code document which allows you to use a smart device to review individual sections.

Drivers

Respiratory disease is identified as a clinical priority in the NHS Long Term Plan.
The NHS Accelerated Access Collaborative (AAC) is the umbrella organisation for UK health innovation. It supports the NHS to quickly adopt clinically proven and cost-effective innovations, and to ensure patients get access to the best new treatments and technologies.

The AHSN Network

Local Contacts

Clinical pathways, guidelines, and guidance

NICE guidelines | NICE guidance | Our programmes | What we do | About | NICE
You can review the wider NICE pages on Asthma diagnosis by following this link; Diagnosis | Diagnosis | Asthma | CKS | NICE
Link to interactive NICE Asthma pathway here. For specific guidance on the use of FeNO in the diagnosis of asthma, you can review all information through this link; DG12 - Overview | Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and NObreath | Guidance | NICE.
We have also pulled together a summary of the relevant policies for your information.
The NHS England/Improvement South West Respiratory Clinical Network has developed a pragmatic guide for those introducing the use of FeNO to their practice - Access it here (With Thanks to the SW Respiratory Clinical Network)

FeNO Products

Bedfont - NObreath https://www.nobreath.co.uk/resources/. To view how NObreath works, watch this short video.
Circassia NIOX VERO https://www.niox.com/en-gb/professional-resources. You can access instruction videos of NIOX VERO here. For further product information on NIOX VERO, follow this link https://www.niox.com/en-gb/niox-vero/about-niox-vero/.
These products are referenced in more detail in the NICE report; DG12 - Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO, NIOX VERO and NObreath.
Here you can review a comparison between the two products. This is a short objective comparison of these two devices, created by Wessex AHSN.

Ardens Templates

Ardens, providers of TPP SystmOne and EMIS Web templates and resources, have created templates to support the use of FeNO testing and associated data collection.

Available to all TPP and EMIS users free of charge - regardless whether a practice is an existing Ardens customer.

Download the guidance document here - which contains links to and descriptions on how to access the templates.

Guidance details are also available on the Ardens FeNO template webpage.

You can also download a Data Protection Impact Assessment (DPIA) template to support data sharing here.

If you do not use Ardens, then an Excel based reporting template has been developed - download it here. Guidance specific to use of the Excel based reporting template is downloadable here.

FeNO Learning Collaborative

Our FeNO Learning Collaboratives aim to bring together people interested in FeNO, planning to use FeNO or who are already using FeNO in their practice.

You can register for the next FeNO Learning Collaborative here

You can see resources and recordings from past Collaboratives here

Infection Control

ARTP COVID 19 Pandemic Guidance

1. Bedfont general information and guidance around Coronavirus

2. Guidance on care of NObreath product

3. Guidance and care of NIOX VERO product

In addition to the product specific guidance, use the links below to review wider sources of advice.

https://rms.kernowccg.nhs.uk/content/SW%20Respiratory%20Network%20ARTP%20Guidelines%20for%20Lung%20Function%20Testing%20V1.1.pdf

https://www.pcrs-uk.org/coronavirus

https://www.artp.org.uk/News/artp-covid19-april2020

Case Studies

Support with Business Case Development

We have created a template Case for Change to support clinical teams looking to implement FeNO testing at scale. This Case for Change template is supported by an interactive data dashboard that allows you to identify the cost of asthma across CCGs in England, and estimate the cost of FeNO equipment as part of your project deployment.
Our colleagues at Eastern AHSN have developed a tool to help you think through the elements needed for a successful business case. You can access the toolkit here following a short data capture page (our thanks to our colleagues at Eastern AHSN for access to this great tool).

A table of funding examples shows the funding opportunities and the application process required. The AHSN may be able to offer support with the application process.
You can view a case study of the impact of FeNO diagnostics on medicines costs here.

Searches for undiagnosed asthma and disease prevalence

To identify patients who could have their care improved by clarifying their diagnosis, practices can run a simple system search using criteria that can include, for example, specific respiratory symptoms and/or repeat prescriptions of inhalers or oral steroids and/or those coded 'suspected asthma'. Alternatively, practices can use ePACT2 / NHSBSA prescription data dashboards to generate lists of patients who have been prescribed these medicines.
CDRC Precision digital resources are developed by clinicians in the North East of England, working on existing clinical IT systems (SystmOne and EMIS) and are quality assured by the North of England Care Support Unit (NECS). You can contact CDRC to access these tools using this link; Resources - Clinical Digital Resource Collaborative (cdrc.nhs.uk).
UCLP proactive care frameworks provide a platform for optimising clinical care and self-care for people asthma and COPD, supporting primary care teams to do things differently and at scale (Asthma and COPD). For more information you can visit https://uclpartners.com/proactive-care/. To understand more about the prevalence of asthma and other respiratory diseases, we have included examples of accessible supporting data/information below;

https://fingertips.phe.org.uk/search/asthma

https://fingertips.phe.org.uk/profile/inhale

https://openprescribing.net/

https://www.respiratoryfutures.org.uk/

https://www.england.nhs.uk/rightcare/products/nhs-rightcare-intelligence-tools-and-support/

https://www.nhsbsa.nhs.uk/prescription-data

https://statistics.blf.org.uk/asthma

Implementation and Reporting

To get you started we have produced a simple slide deck showcasing the Plan Do Study Act (PDSA) methodology, along with a checklist of items to consider. You can access this slide deck here.
In addition you can print out this summary check list to 'tick off' elements as they are considered and completed.
Download and tailor this project plan template to help you manage your FeNO planning.
It can be really helpful to plan projects as a mixed group. Inviting your key stakeholders and contributors along to develop and structure your project. To assist you we have developed this Action Learning Set Template which has been designed to take you through from project initiation through to planning, implementation and evaluation.
AAC PTF Governance - for ACC Pathway Transformation Funds awardees only.
In order to access FeNO products through the PTF process there are some simple steps to follow. Please review the overarching Governance document as part of your project planning.
There is a requirement to evidence training completed in order to access the FeNO products. You can review the Guidance document for product release here and the pro forma to record you training here.
As part of the Pathway Transformation Fund (PTF) contract, there is a requirement to submit updates of your project along the way, along with a final evaluation report. You can access these report templates using the links below;
check point report template
Final report template
Download suggested FeNO clinical codes (SNOMED CT) here

Patient Communications

You can access a copy of the Patient Guidance leaflet using this link
You can download this leaflet in 7 languages, here
Circassia have developed and published a patient leaflet that you can access here.
You can also view an example of local Trust patient communications here.

Help for Patients

Asthma tests (Diagnosing asthma in adults | Asthma UK)
You may be given a peak flow meter to use at home for a couple of weeks. This is so you can record your own peak flow scores in a diary.
The good news is there are lots of effective medicines available to help manage your symptoms. With the right treatment plan and good support from your GP you could stay symptom free.
An asthma action plan is a simple tool to help you manage your asthma well. You fill it in with your GP or asthma nurse
Once you have a confirmed diagnosis of asthma, it is important that you learn to use your inhalers correctly. Asthma UK has a number of educational videos that allow you to review technique for your specific inhaler. You can access these videos via this link How to use your inhaler | Asthma UK.
For more detail, information and advice please go to www.asthma.org.uk

Education Toolkit

Our team of clinical educators have been working on a free of change, CPD accredited, clinical education piece that will be available in July. It will be accessible via this site.
You can also view Asthma UK advice on FeNO testing by following the link below https://www.asthma.org.uk/advice/diagnosis/tests/#Feno
You can review all of the NICE diagnostic protocols, using the links below;
Algorithm A. Initial clinical assessment for adults young people and children with suspected asthma
Algorithm B. Objective tests for asthma in children and young people aged 5 to 16
Algorithm C. Objective tests for asthma in adults aged 17 and over

Meet the team

Back to FeNO - Fractional exhaled nitric oxide - for the diagnosis and management of Asthma >

Resources at a glance

Programme(s): FeNO - Fractional exhaled nitric oxide - for the diagnosis and management of Asthma

Meet the team

Programme(s):
FeNO - Fractional exhaled nitric oxide - for the diagnosis and management of Asthma