American Thoracic Society (ATS) recommendations for

Interpreting LOW FeNO Measurement

Low FeNO (<25 ppb [<20 ppb in patients <12 years of age]): implies
noneosinophilic or no airway inflammation*

Diagnosis of a symptomatic patient Monitoring of a symptomatic patient with

(chronic cough and/or wheeze and/ an established diagnosis of asthma
or shortness of breath for >6 weeks) Asthma
presenting for the first time
Noneosinophilic asthma
Possible pulmonary/airway causes (probably steroid unresponsive)

Rhinosinusitis Possible additional or alternative diagnoses

Noneosinophilic asthma  Vocal cord dysfunction
 Reactive airways dysfunction syndrome  Anxiety-hyperventilation
COPD  Bronchiectasis
 Bronchiectasis  Cardiac disease
Cystic fibrosis, primary ciliary dyskinesia  Rhinosinusitis
Gastroesophageal reflux disease
 Extended postviral bronchial
hyperresponsiveness syndrome
 Vocal cord dysfunction
Monitoring of an asymptomatic patient
with an established diagnosis of asthma
Nonpulmonary/Nonairway causes
 Anxiety-hyperventilation Low FeNO levels indicate adequate dosing
and good adherence to corticosteroid therapy
 Gastroesophageal reflux disease
Inhaled corticosteroid dose may possibly
Cardiac disease/pulmonary hypertension/ be reduced (repeat FeNO 4 weeks later to
pulmonary embolism
confirm this judgment; if it remains low then
Confounding factors relapse is unlikely)
 Smoking
 Obesity

Patient is unlikely to benefit from a trial

of inhaled corticosteroid treatment

COPD = chronic obstructive pulmonary disease; FeNO = fractional exhaled nitric oxide.
*The interpretation of FeNO is an adjunct measure to history, physical exam, and lung function assessment.
Adapted from Dweik RA et al. Am J Respir Crit Care Med. 2011; 184:602-615; with permission of the American Thoracic Society.
Copyright © 2011 American Thoracic Society.

NIOX MINO® is intended to be used as a quantitative, noninvasive method of measuring

changes in FeNO levels to determine the therapeutic effect of anti-inflammatory medications
in patients with asthma. Please see full Intended Use document at www.nioxmino.com for
more information on the use of NIOX MINO in patients with asthma.

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American Thoracic Society (ATS) recommendations for
Interpreting HIGH FeNO Me asurement
High FeNO (>50 ppb [>35 ppb in patients <12 years of age]) or rising
FeNO (>40% change from previously stable levels): implies uncontrolled
or deteriorating eosinophilic airway inflammation1*

Diagnosis of a symptomatic patient Monitoring of a symptomatic patient with

(chronic cough and/or wheeze and/ an established diagnosis of asthma
or shortness of breath for >6 weeks) Possible etiologies
presenting for the first time High persistent allergen exposure
Possible etiologies Inhaled corticosteroid delivery problems
A
 topic asthma – Poor adherence
– Poor inhaler technique
E
 osinophilic bronchitis
 roximal drug deposition, with untreated distal airway/
–P
C
 OPD with mixed inflammatory phenotype alveolar inflammation

 Inadequate corticosteroid dose

Patient is likely to benefit from a trial
of inhaled corticosteroid treatment Rarely: steroid-resistant asthma, Churg
Strauss syndrome, or pulmonary eosinophilia

Monitoring of an asymptomatic patient with an established diagnosis of asthma

No change in inhaled corticosteroid dosing, but refer to FeNO trend over time in
individual patient
Withdrawing inhaled corticosteroid is likely to be followed by a relapse
An increase in therapy is indicated as some patients are asymptomatic, but the high FeNO could
be a risk factor for an upcoming exacerbation
“High” FeNO may be normal in a certain percent of the population

COPD = chronic obstructive pulmonary disease; FeNO = fractional exhaled nitric oxide.
*The interpretation of FeNO is an adjunct measure to history, physical exam, and lung function assessment.
Adapted from Dweik RA et al. Am J Respir Crit Care Med. 2011;184:602-615; with permission of the American Thoracic Society.
Copyright © 2011 American Thoracic Society.

Reference: Dweik RA, Boggs PB, Erzurum SC, et al; on behalf of the American Thoracic Society Committee on Interpretation
of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of
exhaled nitric oxide levels (FeNO) for clinical applications. Am J Respir Crit Care Med. 2011;184:602-615.

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