Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FeNO) in asthma reviews

Marta Santillo; Ben Ainsworth; Michelle Helena Van Velthoven; Lucy Yardley; Mike Thomas; Kay Wang; Sarah  Tonkin-Crine

doi:10.1038/s41533-022-00272-0

Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FeNO) in asthma reviews

Marta Santillo, Ben Ainsworth, Michelle Helena Van Velthoven, Lucy Yardley, Mike Thomas, Kay Wang, Sarah Tonkin-Crine

Research output: Contribution to journal › Article › peer-review

3 Citations (SciVal)

Abstract

Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.

Original language	English
Article number	13
Journal	npj Primary Care Respiratory Medicine
Volume	32
Issue number	1
Early online date	21 Mar 2022
DOIs	https://doi.org/10.1038/s41533-022-00272-0
Publication status	Published - 31 Dec 2022

Bibliographical note

Funding Information:
We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Public Health, Environmental and Occupational Health
Family Practice

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s41533-022-00272-0Licence: CC BY

Cite this

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title = "Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FeNO) in asthma reviews",

abstract = "Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.",

author = "Marta Santillo and Ben Ainsworth and {Van Velthoven}, {Michelle Helena} and Lucy Yardley and Mike Thomas and Kay Wang and Sarah Tonkin-Crine",

note = "Funding Information: We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. ",

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AU - Ainsworth, Ben

AU - Van Velthoven, Michelle Helena

AU - Yardley, Lucy

AU - Thomas, Mike

AU - Wang, Kay

AU - Tonkin-Crine, Sarah

N1 - Funding Information: We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: We would like to thank our PPI representatives, Christine Rutherford, Richard Harris, Daniel Russel, Penny Kunorubwe, Susannah Fleming, Joshua Inwards (Svetlana Inwards), Tyler Hall (Mandy Hall), Nick Ambrosetti (Daniela Bisci Ambrosetti), for their help with the design of this study and the intervention, reviewing the participant materials, and for their feedback on the key findings and this manuscript. This project is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme (project reference RP-PG-0618-20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder of the study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

PY - 2022/12/31

Y1 - 2022/12/31

N2 - Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.

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Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FeNO) in asthma reviews

Abstract

Bibliographical note

ASJC Scopus subject areas

UN SDGs

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