Exhaled nitric oxide as a tool in managing and monitoring difficult-to-treat asthma

Most patients diagnosed with asthma maintain control reasonably well and do not experience asthma exacerbations; however, on average, 30% of patients achieve suboptimal control, have severe or difficult-to-treat asthma, and are relatively nonresponsive to the same medications that achieve and maintain asthma control for most patients. This small patient population of difficult-to-treat or severe asthma accounts for 80% of asthma medical costs. This study was designed to determine the potential U.S. payer cost savings resulting from an asthma specialist incorporating fractionated exhaled nitric oxide (FENO) as an asthma management or monitoring tool to guide treatment of difficult-to-treat asthma patients. We present an annual medical resource use scenario typical of a difficult-to-treat asthma patient as well as five hypothetical scenarios of annual medical resource use for a difficult-to-treat asthma patient being managed with regular FENO measurements in addition to current standard asthma management guidelines. We used the most conservative estimate of the potential asthma cost savings when FENO measurement is used for difficult-to-treat asthma. The most likely clinical scenario assumes a 5% reduction in hospitalization and emergency department costs only. The inclusion of FENO measurements to the asthma management strategy would essentially reach parity with the current standard of care, despite the additional cost of FENO measurements. Additional scenarios were examined, all showed cost and use reduction across all medical resource usage categories. Use of exhaled NO measurement to guide asthma management, maintenance, and control in difficult-to-treat asthma would almost certainly result in cost savings to the payer. (Allergy Asthma Proc 32:185-192, 2011; doi: 10.2500/aap.2011.32.3449)