A possible correlation: FeNO and Covid-19

MPN editor Laura Hughes sat down with Jason Smith, managing director at Bedfont Scientific, to find out about the company’s research reviewing a possible link between Fractional exhaled Nitric Oxide (FeNO) and Covid-19.

Bedfont Scientific has developed the breath analysis medical device, NObreath, which measures FeNO. Smith explained how the device was first developed in 2008 as a non-invasive aid in the management and diagnosis of asthma. He said, “the device works by analysing a breath sample and providing a FeNO reading in Parts Per Billion (PPB) which reflects a patient’s level of airway inflammation. The higher the level of FeNO, the higher the level of airway inflammation, indicating either undiagnosed or uncontrolled asthma.”

Ten years later, the second generation NObreath device was launched. This device differed to the original, with both new aesthetic and functional features designed to meet the market needs and demands. These included, verification of successful breath tests, onscreen motivational exhalations guides, and a new aesthetically pleasing look with easily-serviceable parts.

Smith explained how, “one of the aesthetic updates was the move away from rubber casing to a polycarbonate/ABS blend, which enabled the NObreath to have a more stylish but clinical look.” The device also has a purple bezel to keep a splash of colour and to remain in line with the company branding. Additionally, the plastic casing of the NObreath now also incorporates SteriTouch antimicrobial technology for optimum infection control as a medical device.

In terms of the lifespan, “NObreath has an unlimited testing lifespan and only requires one yearly service,” Smith highlighted. The polycarbonate/ABS blend casing around the serviceable parts also means that the annual service is quick and easy to perform.

Prior to the pandemic, the device was being used in both primary and secondary care to assist with the diagnosis and management of asthma. Regular FeNO measurements indicate levels of airway inflammation, which can help healthcare professionals with a more tailored asthma diagnosis by preventing over-/under-/mis-diagnosis, as well as improving asthma management. FeNO measurements can be also be used to evaluate the effectiveness of inhaler technique, and also an individual’s ICS dosing.

However, during the pandemic, Smith discussed how a colleague suggested the potential role of FeNO levels in Covid-19: “One of our medical advisory board members, Prof. de Paula Vieira, explained to us that high levels of FeNO have been associated with bronchial inflammation, remodelling (fibrosis) and hyper-responsiveness in asthmatic patients, and especially asthma severity and prognosis. Thus, due to the nature of the inflammatory and rapid fibrotic process found in Covid-19 patients, he hypothesised that Covid-19 patients could present high levels of FeNO at the beginning of the disease. In addition, some mild and moderate symptomatic patients presenting Covid-19 symptoms have come to the hospital and some of them develop a more severe form of Covid-19.”

At the time, Bedfont had received lots of correspondence asking for medical and technical innovations that could help the current pandemic and so when Prof. de Paula Vieira approached the company with his theory, Smith said, “we thought it essential to explore whether FeNO had a direct correlation to Covid-19 and donated the monitors and consumables necessary for the study.”

Currently, research is still in the early stages. A number of hospitals are participating, and FeNO testing is being conducted alongside other parameters. Prof. de Paula Vieira hopes to run this study for roughly another four months to ensure the data is robust.

In terms of study completion, Smith commented: “We hope to have some preliminary results by August, as one of the hospitals used for Covid-19 referrals is looking to test 400-500 non-hospitalised patients, and around 100 hospitalised patients. We aim to have collected enough data to finish the study in about four months’ time, and the final results should be analysed and released shortly after this.”

According to Smith, the organisation does not believe anyone else is actively reviewing a possible link between FeNO and Covid-19.