Can someone please explain feno levels ?

[Mummynuthouse]

I have been in hospital more times than I care to count since my last post, I'm taking all my medication as prescribed, however I saw my consultant on Monday, where I had a feno test, which come up at 198, this is normal for me, (unless I go back to smoking where it drops to about 90) today I had my 2nd biological jab, the asthma nurse got me to do another feno test, which come out at 262, however on Tuesday I had to have ambulance and trip to hospital twice as attacks were that bad. Not sure if the attacks would make the feno levels raise or not. Guess I am confused as no one has really explained what the feno test does and why my numbers are a little high. Any advice would be appreciated

[EmmaF91 Community Ambassador]

Hi

Feno/NIOX is the level of nitrous oxide that your lungs are producing. Often this can be a sign that inflammation is going on but there are other factors involved too. For example, as you have seen, smoking can dramatically lower your score whilst nitrate-rich foods (lettuce, beetroot, spinach, kale etc etc) can increase it.

The other things that can affect your score is the wrong technique. You’re meant to fully inflate your lungs (on the breathe in) before you do it - something that many people don’t do!!

Everyone is different in their response to attacks also. Some people find their score peaks just before attacks (ie with meds it calms) others find that it’s the time afterwards that it builds up even thought you’re now symptom free.

Theoretically a score higher than 50 suggests that you’re inflamed to the point of needing steroids/increasing of maintenance meds and a score over 25 suggests that whilst steroids *may* help, they won’t necessarily do any thing.

But after that the ‘how high’ your number is doesn’t necessarily equate to ‘how bad’ you are. I’ll always remember being told by my team that the highest score they’ve seen was over 300. They were surprised as they DID NOT expect that patient to have that score. Turns out he had just given up smoking (on their advice) but had also decided to not use his inhaler for a couple weeks (cause ‘is it really needed?’ 🙄🤦‍♀️). He didn’t have any asthma symptoms going on at the time (or the day’s pre/post) and the next time they say him (6 months no smoking, and on inhalers) he was under 50. Then they look at me where I can be really unwell and in resus etc when in the 90s and that might increase to 198 over the next few days.

Hope this helps to explain things a bit.

[Pipsqueak77]

HiPersonally I find FeNO levels really useful..

I know that certain things can interfere including chest infections but on the whole I think your smoking might be the only thing you need to consider and make allowance for unless you have an active chest infection maybe?

If my FeNO is high - it is generally when I am poorly ( 100-200 ppb) and if it’s low (25-50 ppb) I am usually ok.! I know that sounds very simplistic but I do find it really helpful... I wish I had one at home!

I hope you are able to get your levels ( and asthma) sorted soon!

👍😊

[EmmaF91 Community Ambassador in reply to Pipsqueak77]

Yup for some asthmatics feno can be really useful, just not for all asthmatics. So long as you use it as a personal range it’s fine (and no oneupmanship between asthmatics - just like there shouldn’t be with PF! 😉)

But for the non-eosinophilic/non-allergic among us feno isn’t useful at all. Just remember there are multi-faceted causes for issues and that a high number is not indicative of more than ‘maybe steroids (oral OR inhaled) will help’ 😉

For me I find it sorta helpful, but usually it’s quite delayed so in that sense TD really not. I know others who really don’t benefit at all (in fact they feel hindered by it). I know docs who love feno and ones how are a bit meh about it. Over all for some people it helps indicate issues and so long as you use it personally then it can be quite good if it works for you!

As pipsqueak says she personally finds it really useful which is fab and I’m really grad for her! And I hope you’ll find this too in the end mummynuthouse!! 🤞🏻🤞🏻

[Mummynuthouse in reply to EmmaF91]

Tbh I just want a normal life again, all these tests that they get me to do, I get as such, but I'm on oral and inhaled steroids as well as nebs, i was hospitalised 5 times in April, have not been able to come back down to my maintenance dose of steroids as every time I do a wean I end up back in hospital, am constantly tired, my chest area just feels like an elephant is permanently sat on it, my life is being ruled by asthma, it is all allergy-related and given the time of year it is to be expected, I have no chest infections, which is also good. Guess I'm trying to get a better understanding of it all, rather than letting it all go over my head now. It is getting very scary and at 40 I guess I can't keep pretending it doesn't have a hold over me.