The FeNO Programme

As a key partner of NHS England’s Accelerated Access Collaborative (AAC), the AHSN Network has supported the rollout of Fractional exhaled Nitric Oxide (FeNO) testing to improve the asthma pathway in England as part of the AAC Rapid Uptake Products (RUP) programme.

The AHSN NENC provided spread and adoption support regionally from April 2021 to March 2023.



Fractional exhaled Nitric Oxide (FeNO) testing is a simple, non-invasive test to measure the amount of nitric oxide in an exhaled breath – a biomarker for airway inflammation.

FeNO testing can improve patient care by contributing to a faster and more effective asthma diagnosis when used alongside a detailed clinical history and other tests. It can also be used to monitor patient response to asthma treatments.

In 2020, it was noted that FeNO testing had lower-than-expected patient access, presenting an opportunity to improve uptake and support the NHS Long Term Plan ambition of improving early and accurate diagnosis of respiratory conditions by embedding FeNO testing in primary care.


What we did

The programme focused on collaboration at a national, regional and local level across healthcare systems, industry partners, patients, and the community and voluntary sector to integrate FeNO testing into everyday clinical practice.

We worked within our local systems across the North East and North Cumbria to support asthma pathway improvements by taking a pathway-based transformation approach. We provided clinical and transformation leadership, shared best practice and developed education and implementation materials for those involved in providing asthma care.

A package of educational resources to support FeNO implementation, including information documents, podcasts, posters, learning modules and webinars, was created to support clinicians. The toolkits were designed in a practical way to support teams adopting and sustaining the use of FeNO.



The programme aimed to improve patient care and outcomes through enhanced access to diagnostics and treatments for severe asthma. The full impact of the programmes is still being finalised however interim data shows that between April 2021 and February 2023:

  • An estimated 190,818 additional patients benefited from diagnostic FeNO testing across England.
  • 33 Pathway Transformation Fund projects were completed to support wider adoption of FeNO.

For the clinical workforce delivering asthma care the programme has supported learning, training and development.

  • 722 people attended webinars and learning collaboratives related to FeNO.
  • The FeNO online resource toolkit has been accessed more than 13,500 times.


Regional outcomes

A total of 20 FeNO testing devices were secured and shared across 10 sites in the North East and North Cumbria. The sites were spread over the following three lead organisations:

  • North Cumbria CCG
  • Durham Dales PCN
  • County Durham and Darlington NHS Foundation Trust


During the course of the two-year programme in the region:

  • An estimated 1,112 additional patients benefited from diagnostic FeNO testing.
  • 10 Pathway Transformation Fund projects were completed to support wider adoption of FeNO.
  • 67 people attended webinars and learning collaboratives related to FeNO.
  • Over 3,000 tests per month were administered.


Click here to see the Improving Access to FeNO testing in rural communities case study


Next Steps

Due to the significant interest in FeNO testing across the local system, we also purchased 15 additional devices for other sites which were unable to secure them through the RUP programme. A further seven FeNO testing devices were also made available to the region at the end of 2022 which will be disseminated to interested sites in 2023.

The national FeNO programme has now completed and has made substantial contributions to the transformation of asthma care in England while significantly increasing the access to and adoption of FeNO. Learning from the AHSN programmes is being fed into the development of NICE/SIGN/British Thoracic Society asthma guidance, expected in 2024, offering real-world insights to implementation considerations.