Improved diagnostic testing: Helping those with lung conditions

As the winter season approaches, the National Health Service (NHS) prepares for an increase in the number of patients infected with common respiratory viruses. For individuals with respiratory conditions, like the 5.4 million people in the UK who have asthma, the colder months pose a particularly high risk.¹

Image Credit: Antonio Guillem/Shutterstock.com

These individuals may experience constricted airways, difficulty breathing, and tightness in the chest, which are the characteristic yet distressing symptoms of asthma - an inflammatory disorder that affects around 9 % of the population. Individuals with asthma are more susceptible to respiratory infections.^1,2

In addition to the mental and physical strain caused by asthma, there is a significant burden of asthma-related disability in the UK population, with a Disability-Adjusted Life Year (DALY) rate of 350 per 100000 people.³ This burden is evident in the reported 60000 hospital admissions and 200000 bed days for asthma patients each year.¹ Asthma can also be life-threatening: asthma attacks cause the loss of three lives per day.¹

The economic burden of asthma is substantial. In England alone, the direct cost of asthma, which includes NHS expenses, the effects of greenhouse gas emissions, and patient travel costs, has exceeded £1.2 billion this year.¹

Collectively, lung conditions, including asthma, place a yearly burden of £9.6 billion on the NHS and exacerbate healthcare pressures during the winter since individuals with these conditions are also more susceptible to respiratory illnesses and cold weather.¹ Asthma is no longer a personal health concern; it is a public health and economic emergency.

Exacerbating a crisis: Insufficient diagnostic testing hinders effective decision-making

A report released in 2023 by the British charity Asthma + Lung UK highlights the alarming state of lung healthcare in England. Despite lung disease ranking as the third leading cause of death, individuals experiencing breathlessness often wait years before an official diagnosis, while others remain undiagnosed or receive inaccurate diagnoses.¹

According to one study, over 30 % of adults previously diagnosed with asthma could not have their diagnosis confirmed.⁴ The gravity of this issue becomes apparent when considering that an estimated 750000 individuals in England are misdiagnosed with asthma, resulting in financial consequences amounting to approximately £132 million annually.¹

The causes behind these apparent oversights are multifaceted. One contributing factor is the lack of funding and limited access to diagnostic tests, which undermines the reliability of primary care diagnoses. A PricewaterhouseCoopers (PwC) analysis revealed that the current deficiencies in testing are estimated to cost England £2.2 billion, primarily due to avoidable hospital stays and treatments.⁵

To recover some of these expenses and alleviate the strain on the NHS, Asthma + Lung UK has proposed several measures. These include fully funding diagnostic testing, reinstating nationwide spirometry, and maximizing the potential of community diagnostic centers and primary care for diagnoses.

Implementing these measures could result in savings of £307 million and the availability of 273000 beds - over a third of these beds would be available during the critical winter period. This figure greatly surpasses the £250 million emergency funds allocated by the UK government to create an additional 5000 NHS hospital beds for the upcoming winter.¹

Feno testing: Addressing the impact of lung conditions, one breath at a time

Improving diagnostic testing (one of the three recommendations put forth by Asthma + Lung UK) appears to be a realistically achievable goal. The National Institute for Health and Care Excellence (NICE) recommends the use of a single objective test, fractional exhaled nitric oxide (FeNO), for measuring airway inflammation in asthma diagnosis.⁶

FeNO testing involves measuring nitric oxide, a gas naturally produced by cells lining the airways to combat inflammation. In individuals with respiratory conditions, particularly asthma, there is often an increased production of nitric oxide due to localized inflammation.

During a FeNO test, the individual exhales into a specialized device, such as the NObreath^® developed by Bedfont Scientific Ltd., which captures and analyzes the nitric oxide content. The device, with its high sensitivity, measures the concentration of nitric oxide in parts per billion. By interpreting the device's output, valuable information about the extent of airway inflammation can be obtained. Higher FeNO levels indicate greater airway inflammation, often associated with conditions like asthma.⁷

The NObreath^® is a non-invasive FeNO device suitable for both adult and pediatric patients. It adheres to the guidelines set by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). The NObreath^® utilizes a simple exhale-only technique and provides on-screen visual motivation.

Once a breath sample is collected and analyzed, healthcare providers can assess airway inflammation and device treatment responses. Additionally, a patient interpretation guide facilitates result analysis, enabling informed decision-making by healthcare providers.⁷

Despite the simplicity and cost-effectiveness offered by the NObreath^® for asthma diagnosis, FeNO testing and the necessary solutions for accurately evaluating lung health are still not widely available in primary care settings.^5,7 A comprehensive analysis conducted by PwC indicates that universal access to FeNO tests for general practitioners (GPs) across England could lead to around £100 million in savings through optimized asthma treatment.¹ This finding not only highlights the cost-effectiveness of FeNO testing but also underscores its potential to improve patient outcomes by ensuring accurate diagnoses and tailored treatments.

Addressing the call for enhanced diagnostic testing: A nation's battle with lung conditions

The asthma crisis in England presents a complex challenge concerning misdiagnoses and financial strain on the NHS. One potential solution to aid in the accurate diagnosis of lung conditions, including asthma, is the widespread availability of FeNO testing in primary care - which has the potential to save countless lives.

It is imperative that individuals suspected of having lung conditions, such as asthma, have access to FeNO tests and that those who undergo testing receive precise and reliable diagnoses.

By embracing FeNO testing as a fundamental component of asthma management, we can significantly enhance the quality of life for those affected by asthma, reduce healthcare expenses, and alleviate the burden on the NHS. The time to take action is now for the benefit of patients and the healthcare system as a whole. To learn more about the available solutions that can contribute towards more accessible testing, reach out to Bedfont Scientific Ltd.

References and further reading

1. Saving Your Breath: How Better Lung Health Benefits Us All. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/saving-your-breath-report
2. Sharma S, et al. (2022). Vulnerability for Respiratory Infections in Asthma Patients: A Systematic Review. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536399/
3. Nunes C, et al. (2017). Asthma costs and social impact. Asthma Research and Practice. https://pubmed.ncbi.nlm.nih.gov/28078100/
4. Aaron SD, et al. (2017). Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. https://pubmed.ncbi.nlm.nih.gov/28114551/
5. 'Abysmal' lack of testing for lung conditions is forcing GPs to play a 'guessing game' with diagnosis. (2023). Asthma + Lung UK. Available at: https://www.asthmaandlung.org.uk/media/press-releases/abysmal-lack-testing-lung-conditions-forcing-gps-play-guessing-game-diagnosis (Accessed on 09 October 2023).
6. Asthma: diagnosis, monitoring and chronic asthma management. NICE. Available at: https://www.nice.org.uk/guidance/ng80/chapter/Recommendations#objective-tests-for-diagnosing-asthma-in-adults-young-people-and-children-aged-5-and-over (Accessed on 09 October 2023).
7. Nobreath. Available at: https://www.nobreathfeno.com/us/ (Accessed on 09 October 2023).

About Bedfont Scientific

Bedfont^® Scientific has specialized in the design and manufacture of exhaled breath and gas monitoring instruments since 1976.

For medical gas monitoring, their Medi-Gas Check medical pipeline testing range verifies not only the quantity but also the quality of gas administered to patients.

Bedfont's breath analyzers include carbon monoxide (CO) devices such as the Smokerlyzer^®, used for smoking cessation, and the ToxCO^®, used by emergency services, to diagnose CO poisoning.

The NObreath^® FeNO device provides accurate analysis of airway inflammation for the control of asthma, and the Gastrolyzer^® range aids in the detection of gastrointestinal disorders and food intolerances. Quick and non-invasive, breath analysis is the new blood test.

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