Normal FeNo - still asthma?

[InElegantWheeze]

I have had asthma all my life with real variation in how it affects me. As a child I was in hospital a lot but 'grew out of it' then had a terrible time at college/uni before essentially forgetting all about it for most of my 20s and 30s. In about 15 years I had a few flare ups with colds but no longer term symptoms at all. Stopped taking regular inhalers and didn't really think about it much at all.

The last few years however have been a rollercoaster of periods of really severe asthma with recurrent infections interspersed with months of feeling fine. I felt like a fraud for having an appointment with the severe asthma team a few months ago as I was so well and my spirometry and FeNo were much better than they should be.

Since the DC have been back in school I have caught every cold going and required a long course of steroids (still weaning) and repeat antibiotics. I'm taking Fostair x8 (max) a day but it doesn't seem to have upped any protection against the next virus. I've had to go into hospital and the GP for nebulisers. My peak flows are all over the place.

This week I had repeat FeNo testing and it is normal? Good in fact? I don't think I have ever had an out of range reading but mostly this is because I am well at clinic when they do it, but this week I would have expected some change to reflect the increase in symptoms and need for meds.

Everyone is very sure this is asthma and it very much feels like it, but what does the completely normal FeNo mean?!

I'm not sure but as someone with asthma your story sounds similar. Used no inhalers from 14 to 32 then it came back with a vengeance but my feno score is always 60+ . Not sure if that's high. I did have a ct scan which showed bilateral lung scarring. I'm also confused if asthma or not and noone seems to give a clear answer!? I don't think inhalers are meant to stop catching the flu however? Just meant to help your breathing. Do you have chest pain? Only other things could also be slight anxiety as chest can feel worse when worried or allergies? Any sinus problems? I believe mine came back as a result of constant sinus infections which were linked to a septum issue. Either way hope you get to the bottom of it!

Thank you

Your FeNo is really high!

My understanding re inhaled steroids inhalers was always to ramp them up approaching colds and viruses as they damp down the ability for your airways to get inflamed and narrow. So if you increase the dose when schools go back you should have a reduced response to the bugs the dc bring home. It hasn't worked for me though!

If I get a cold, I end up needing a lot of everything to get on an even keel again. There seems to be no way of just having a cold and getting away with it.

Are you under a hospital team?

AI says:

FeNO levels are not always high in people with asthma. The FeNO test is a marker for a specific type of inflammation, and not all asthma cases involve this type of inflammation.
Here are the key reasons why FeNO levels might be normal in a person with asthma:

• Non-Eosinophilic Asthma: Asthma is a heterogeneous disease with different underlying inflammatory processes (phenotypes). FeNO specifically measures eosinophilic (allergic, type 2) inflammation, which is present in about 50% of asthma cases. Patients with other types, such as neutrophilic asthma, can have normal FeNO levels.
• Effective Treatment: Inhaled corticosteroids (ICS) are effective at reducing eosinophilic inflammation and will lower FeNO levels to a normal range if the patient is using their medication correctly and consistently. Normal FeNO in a treated patient often indicates good asthma control.
• Smoking: Smoking has been shown to significantly lower FeNO levels, potentially masking underlying inflammation in asthmatic patients who smoke.
• Other Factors: Various other factors can affect FeNO results, including age, gender, diet (nitrate-rich foods), and recent respiratory infections, which need to be considered during interpretation.

Therefore, a normal FeNO result alone does not rule out asthma. Healthcare professionals use FeNO results in combination with a patient's clinical history, symptoms, and other lung function tests (like spirometry) to make a definitive diagnosis and determine the best course of treatment.

Edit: Sounds like you have the wrong sort of asthma for that test to work!

Oh wow I didn't know that, thank you that's helpful to know. I'm under no-one. My asthma review nurse googled in front of me whether score was high then said try the inhalers. So I did, went back and chest pain hadn't improved so she said well not sure it's asthma and that was the end. Unsurprisingly I've since changed gp surgery so do need a proper review. I sometimes wake up struggling. What does the hospital team do? I understand your frustrations! Definitely keep pushing for more tests! I hope you don't get too poorly over winter

Thank you

You definitely need following up!

Really interesting thank you