FeNO test for child’s asthma diagnosis and treatment review?

[NotTofeno]

Ds (7) was diagnosed with ‘viral wheeze’ aged 18 months. At 3 he was prescribed steroid inhalers to manage this. At 6 we were told it was asthma. He is well
controlled except if unwell we need to increase steroids.

The GP has now told us he might not have asthma. That we have to agree to a feno test to confirm the diagnosis and if negative it means he doesn’t have asthma so we must stop calling it asthma and treating it as asthma?

on looking up this test it seems to actually be to confirm if inhaled steroids are having the desired effect rather than to diagnose asthma?

We’ve declined as feel the GP is misleading us a bit ? Also worried that DS will just end up back in hospital. We thought the period of time to wait and see was when he was labelled as ‘viral wheeze’ aged 18m -3.5? Has anyone else had this testing?
What is it actually for is the Gp correct or is my interpretation correct that it’s a tool to see how well therapy is working not for removing a diagnosis?

To add between 18 m and 3.5 he had 14 admissions to an and e with breathing difficulties. For the first 3 months no inhaler was prescribed and after that just a blue one till he was 3.5 and steroids added (this helped)

The test, which I've had in the last week, tests for the proportion of exhaled nitrous oxide which is much higher in inflamed asthmatic lungs. I had stop my steroid inhaler a week before the test. My test was negative so not asthma, but it's back to the drawing board.

I didn’t realise they make you stop the steroid inhaler beforehand, I wouldn’t be happy with that at all as we had an awful time when he was younger before he was prescribed the steroids. It was terrifying. He still needs it increased each time he’s unwell and needs the relieve if he runs about too much so although he’s technically well controlled it seems a bit fragile as he can deteriorate easily and stopping the brown inhaler would concern me greatly.

FeNO is a way of measuring inflammation in the airways, which is essentially what asthma is. It's now the first line diagnostic test recommended to diagnose asthma in children as well adults. If the result is negative there are other diagnostic tests the GP should order to confirm the diagnosis. It is possible to have a negative feno and still have asthma as there are many subtypes of asthma that can present differently. It sounds like your son has been treated as "suspected asthma" but not had the diagnosis confirmed, which is what the GP is probably trying to do.

FeNO isn't generally recommended for routine monitoring as that can be done with the patients symptom profile usually.

You can see the NICE guidelines which the GP will (should) be working to here

Disclaimer: I'm an adult nurse not a children's nurse but familiar with principles as work in respiratory care

Steroids reduce inflammation so affect the test result. I would speak to your practice nurse who will do the test.

They confirmed asthma when he was 6 and told us they were changing it from viral
wheeze to asthma as that’s what it was. Suddenly they are wanting to look at it again ? I just dont want to go back to the days of fear over his breathing as it was terrifying and we were rushing to hospital so often.

I'm sorry I missed that bit of your OP. Not sure why they would repeat FENO if diagnosis is already confirmed. Except possibly in the case of poor control to identify ongoing airway inflammation to guide treatment options. Which it doesn't sound as if he is as his asthma sounds better controlled with the steroid inhaler. I agree with the poster above, make an appointment to speak with your practice nurse who does the asthma reviews to get a clear plan.

It sounds like a tick box. All than diagnoses in GP need a recorded objective test such as feno. QOF box ticking to ensure the surgery gets ££