Exhaled nitric oxide or FEF25%–75% Balancing diagnostic value with efficacy despite evidentiary uncertainty

We appreciate the comments1,2 on our recent publication investigating the value of exhaled nitric oxide (FeNO) in predicting the outcome of a methacholine challenge (MCH) in adults with respiratory symptoms presenting to a tertiary care center.3 Despite our hypothesis not being confirmed, the performance profile of FeNO (inexpensive, point of care, information predicting treatment response) makes this testing modality attractive compared with MCH testing (more expensive, logistically more cumbersome, helpful primarily when the result is negative).

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