Exhaled Nitric Oxide Measurement Using Niox or Niox Mino
Aim: To assess the safety, effectiveness, and cost effectiveness of exhaled nitric oxide FENO measurement using NIOX or NIOX MINO in managing respiratory diseases, especially asthma.
Conclusions and results: The evidence shows that FENO measurement is safe and noninvasive. A good level of evidence shows good correlation between FENO values as measured by using the two devices (NIOX and NIOX MINO). FENO measurement provides superior diagnostic accuracy compared to conventional tests for diagnosing asthma. It can be used as a predictor of steroid response and loss of control in asthma following steroid withdrawal. There was limited evidence to establish the relationship between FENO and compliance with inhaled corticosteroids and its role in diagnosing and monitoring other respiratory diseases. The evidence shows that the use of FENO in treatment decisions is less costly than asthma management based on standard guidelines.
Recommendations: Based on the review mentioned above, FENO measurement can be recommended for use in Ministry of Health facilities having chest physicians (adult and pediatric), particularly for diagnosing asthma.
Methods: PubMed, Ovid, ProQuest, Cochrane, Food and Drug Administration (FDA), and HTA databases were searched, among others. Additional articles were identified from reviewing the bibliographies of retrieved articles. No limitations were placed on language. We used the Critical Appraisal Skills Program (CASP) to appraise relevant articles. Using the Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001) we graded evidence according to the levels of evidence for assessing diagnosis.
Further research/reviews required: Effectiveness in management of other respiratory diseases.
Written by: Dr Junainah Sabirin, MaHTAS, Malaysia