Diagnosing asthma in children is often more challenging than diagnosing adults. Symptoms can be unclear, children may struggle to describe their feelings and traditional lung function tests are difficult for many under tens to perform consistently. Fractional exhaled nitric oxide FeNO testing offers clinicians an objective, child friendly way to assess airway inflammation and support earlier, more confident diagnosis.
FeNO is increasingly recognised as a valuable tool for paediatric asthma pathways in both primary and secondary care, helping clinicians act sooner and avoid unnecessary uncertainty for families.
Why asthma is harder to diagnose in children
Asthma in younger patients can present with variable, non specific symptoms such as cough, wheeze, breathlessness or recurrent respiratory infections. Children may have normal lung function between episodes and spirometry often requires understanding and effort that younger children cannot provide reliably. FeNO testing bypasses these challenges by measuring airway inflammation directly, rather than relying on symptom interpretation or high effort tests.A simple, child friendly testing experience
FeNO testing requires only a slow, steady exhalation into a handheld device. The process is calm, non invasive and suitable for most children aged five and above. There are no needles, medications or complex instructions, making it well suited for both primary care and clinic environments. Many devices provide clear visual prompts on screen, helping children pace their breathing and stay engaged during the test.Key benefits for younger patients:
- Fast measurement, usually under 10 seconds
- No need for forceful breathing
- Easy to repeat if required
- No discomfort and minimal anxiety
Identifying inflammation early
Detecting airway inflammation early is essential for preventing long term harm. FeNO provides a reading in parts per billion ppb that helps clinicians identify eosinophilic inflammation at the time of testing.A raised FeNO result may indicate:
- Asthma driven by type 2 inflammation
- Likely response to inhaled corticosteroids
- Increased risk of flare ups
- The need for closer monitoring
Making treatment decisions with confidence
One of the major benefits of using FeNO in children is its role in guiding asthma treatment. Clinical teams can use FeNO results to determine whether inhaled corticosteroids are appropriate, whether adherence has improved inflammation and when it may be safe to step down therapy. This clarity helps avoid unnecessary medication while ensuring children who need treatment get it early enough to prevent deterioration.Improving adherence for children and families
Understanding asthma can be confusing for children and parents. An objective FeNO number helps bridge the gap between symptoms and treatment. When a rising FeNO reveals inflammation despite symptom control, children and families are more likely to adhere to prescribed inhalers. Conversely, falling FeNO levels can reassure parents that treatment is working and encourage ongoing adherence.FeNO supports:
- Shared decision making with families
- Better inhaler confidence
- Engagement during reviews
- Early action planning
Supporting school aged children
FeNO is particularly valuable for evaluating children during peak asthma risk periods, including:- September return to school
- Winter viral season
- Allergy flare ups
- Transitioning care between services
A valuable tool for safeguarding future health
Uncontrolled paediatric asthma can affect lung growth, school attendance, sleep quality and long term lung outcomes. By integrating FeNO into routine paediatric pathways, clinicians can intervene when inflammation is active, not only when symptoms are reported. FeNO helps ensure:- Consistent care across primary and secondary services
- Proactive identification of risk
- Better outcomes through early intervention
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