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Tufvesson E, Nilsson E, Popov TA, Hesselstrand R, Bjermer L. Fractional exhaled breath temperature in patients with asthma, chronic obstructive pulmonary disease, or systemic sclerosis compared to healthy controls. Eur Clin Respir J 2020; 7:1747014. [PMID: 32363017 PMCID: PMC7178872 DOI: 10.1080/20018525.2020.1747014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Exhaled breath temperature has been suggested to reflect airway inflammation, and it would be plausible to measure the peripheral airway temperature as a correlate to peripheral airway inflammation. This study aims to explore the relative peripheral airway temperature in patients with asthma, chronic obstructive pulmonary disease (COPD) or systemic sclerosis (SSc) compared to healthy controls, and relate to lung function and exhaled nitric oxide. Sixty-five subjects (16 asthmatics, 18 COPD patients, 17 SSc patients and 14 healthy subjects) performed fractional exhaled breath temperature measurements using a novel device, fractional exhaled NO measurements, spirometry, impulse oscillometry, body plethysmography and CO-diffusion capacity test. A significant overall difference among all the patient groups was seen in both the Tmax (= peak values of the entire exhalation) and T3max (= peak value of the last fraction of the exhaled volume). A significant difference in T3/T1 ratio (= the ratio of peripheral versus central air temperature) was found between asthmatic subjects and those with COPD or SSc. In addition, T1max (= temperature in the central), T3max (= peripheral airways) and the T3/T1ratio related to several volumetric measurements (both in absolute values and as percent predicted), such as vital capacity, total lung capacity, forced expiratory volume in 1 s, and diffusion capacity. The temperature ratio of the peripheral versus central airways was lower in patients with COPD or SSc compared to asthmatics, who in turn presented similar levels as the controls. There was also a large overlap between the groups. Overall, the airway temperatures were related to absolute lung volumes, and specifically, the peripheral temperature was related to the gas diffusion capacity (% predicted), suggesting a link to the vascular component.
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Affiliation(s)
- Ellen Tufvesson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, and Skåne University Hospital Lund, Lund, Sweden
| | - Erik Nilsson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, and Skåne University Hospital Lund, Lund, Sweden
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Clinic of Occupational Diseases, Sofia, Bulgaria
| | - Roger Hesselstrand
- Rheumatology, Department of Clinical Sciences Lund, Lund University, and Skåne University Hospital Lund, Lund, Sweden
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, and Skåne University Hospital Lund, Lund, Sweden
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Parisi GF, Papale M, Tardino L, Nenna R, Midulla F, Leonardi S. Biomarkers in Pediatric Lung Diseases Including Cystic Fibrosis. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x15666190521112824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In recent decades, scientific studies of chemical processes involving metabolites have been
steadily increasing, indicating that we are well into the metabolomics era. This has resulted in
numerous studies that explore the field of biomarkers. One of the medical areas most concerned with
these innovations is certainly that of childhood respiratory disorders, including asthma and cystic
fibrosis. This current study is a review of the literature about biomarkers used or studied in the field
of pediatric pulmonology, including asthma and cystic fibrosis.
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Affiliation(s)
- Giuseppe Fabio Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Papale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lucia Tardino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaella Nenna
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Fabio Midulla
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
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Sol IS, Kim YH, Kim SY, Choi SH, Kim HR, Kim KW, Sohn MH. Exhaled breath temperature as a tool for monitoring asthma control after an attack in children. Pediatr Pulmonol 2019; 54:230-236. [PMID: 30609317 DOI: 10.1002/ppul.24225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/05/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Exhaled breath temperature (EBT) has been suggested as a non-invasive marker of airway inflammation in asthma. There have been no studies examining longitudinal changes in EBT following asthma attacks. OBJECTIVE To investigate changes in EBT during and after an asthma attack and to relate these changes to changes in respiratory physiological measurements. METHODS We evaluated 38 hospitalized children aged 5-18 years diagnosed with an asthma attack. Spirometry was performed upon hospitalization. During hospitalization, EBT, peak expiratory flow rate (PEFR), and asthma score were measured daily. These tests were repeated 1 week and 1 month after discharge. The overall PEFR change, temporal changes in plateau values at the end of expiration, and time-dynamic associations were evaluated using linear mixed models. RESULTS FEV1 was lower at admission than at discharge (63.3 ± 24 vs 99.5 ± 14 percent of predicted, P < 0.001). The EBT was higher at admission than at 1 week after discharge (34.1°C [range: 33.9-34.8°C] vs 33.6°C [range: 33.0-34.2°C], P = 0.007); overall, EBTs decreased over time (P = 0.007). Among individual subjects, decreased EBT was correlated with increased PEFR over time. Furthermore, plateau values at the end of expiration had a time-dependent, dynamic association with the PEFR during hospitalization (P = 0.005) and between asthma attack onset and asthma status stabilization (P = 0.032). CONCLUSIONS The EBT was elevated during asthma attacks and gradually decreased until asthma was well controlled. The EBT may be a useful, non-invasive tool for monitoring asthma control in children.
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Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ha Choi
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ran Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Ferraro V, Carraro S, Bozzetto S, Zanconato S, Baraldi E. Exhaled biomarkers in childhood asthma: old and new approaches. Asthma Res Pract 2018; 4:9. [PMID: 30094051 PMCID: PMC6081883 DOI: 10.1186/s40733-018-0045-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Asthma is a chronic condition usually characterized by underlying inflammation. The study of asthmatic inflammation is of the utmost importance for both diagnostic and monitoring purposes. The gold standard for investigating airway inflammation is bronchoscopy, with bronchoalveolar lavage and bronchial biopsy, but the invasiveness of such procedures limits their use in children. For this reason, in the last decades there has been a growing interest for the development of noninvasive methods. Main body In the present review, we describe the most important non-invasive methods for the study of airway inflammation in children, focusing on the measure of the fractional exhaled nitric oxide (feNO), on the measure of the exhaled breath temperature (EBT) and on the analysis of both exhaled breath condensate (EBC) and exhaled air (Volatile Organic Compounds, VOCs), using targeted and untargeted approaches. We summarize what is currently known on the topic of exhaled biomarkers in childhood asthma, with a special emphasis on emerging approaches, underlining the role of exhaled biomarkers in the diagnosis, management and treatment of asthma, and their potential for the development of personalized treatments. Conclusion Among non-invasive methods to study asthma, exhaled breath analysis remains one of the most interesting approaches, feNO and “-omic” sciences seem promising for the purpose of characterizing biomarkers of this disease.
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Affiliation(s)
- Valentina Ferraro
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Sara Bozzetto
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Stefania Zanconato
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padova, Padova, Italy
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Ntontsi P, Bakakos P, Papathanasiou E, Tsilogianni Z, Kostikas K, Hillas G, Papatheodorou G, Koulouris N, Papiris S, Loukides S. Exhaled breath temperature in optimally treated asthmatics: severity and underlying mechanisms. J Breath Res 2018; 12:026013. [PMID: 29176061 DOI: 10.1088/1752-7163/aa9d46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Increased vascularity may lead to loss of heat in the airways and may modulate exhaled breath temperature (EBT). Increased EBT has been associated with uncontrolled asthma. AIM We wanted to determine whether the measurement of EBT in optimally treated asthmatic patients is influenced by the increased vascular permeability and whether Vascular endothelial growth factor (VEGF) is implicated in the above process. Furthermore, to assess the impact of asthma severity on EBT values. The diagnostic performance of EBT for the identification of inflammatory profiles in induced sputum was also assessed. METHODS 88 stable asthmatic patients optimally treated for at least 6 months were studied (46 with Severe Refractory Asthma, SRA). EBT was measured with the X-halo device. All patients underwent spirometry, sputum induction for the measurement of % inflammatory cells and for the assessment of both VEGF and albumin in sputum supernatant. The airway vascular permeability index was calculated as the ratio of albumin concentrations in induced sputum and serum. RESULTS EBT (°C) was significantly higher in patients with SRA compared to those with mild to moderate asthma (median IQR 34.2 [32.4-34.6] versus 31.8 [26.3-34.1], p = 0.001). EBT was significantly associated with VEGF levels in sputum supernatant, while SRA was recognized as a significant co-variate. No other significant associations were observed. Finally, in ROC analysis, the diagnostic performance of EBT for the pure eosinophilic or/and neutrophilic profile did not reach statistical significance. CONCLUSION EBT is increasing in severe asthma and is significantly modulated by VEGF levels. Despite the above results its performance for predicting cellular profiles is of limited value.
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Affiliation(s)
- Polyxeni Ntontsi
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Shields MD, ALQahtani F, Rivey MP, McElnay JC. Mobile direct observation of therapy (MDOT) - A rapid systematic review and pilot study in children with asthma. PLoS One 2018; 13:e0190031. [PMID: 29401500 PMCID: PMC5798760 DOI: 10.1371/journal.pone.0190031] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
We describe, for the first time, the use of a mobile device platform for remote direct observation of inhaler use and technique. The research programme commenced with a rapid systematic review of mobile device (or videophone) use for direct observation of therapy (MDOT). Ten studies (mainly pilots) were identified involving patients with tuberculosis, sickle cell disease and Alzheimer's disease. New studies are ongoing (ClinicalTrials.gov website) in TB, stroke, sickle cell disease, HIV and opioid dependence. Having identified no prior use of MDOT in inhaler monitoring, we implemented a feasibility study in 12 healthy volunteer children (2-12 years; 8 females and 4 males) over a period of 14 days, with twice daily video upload of their 'dummy' inhaler use. Two children uploaded 100% of the requested videos, with only one child having an inhaler upload rate of <75%. The quality of uploaded videos was generally good (only 1.7% of unacceptable quality for evaluation). The final aspect of the research was a pilot study using MDOT (6 weeks) in 22 children with difficult to treat asthma. Healthcare professionals evaluated inhaler technique using uploaded videos and provided telephone instruction on improving inhaler use. The main outcomes were assessed at week 12 post initiation of MDOT. By week 5, all children still engaging in MDOT (n = 18) were judged to have effective inhaler technique. Spirometry values did not vary to a significantly significant degree between baseline and 12 weeks (P>0.05), however, mean fraction of exhaled nitric oxide (FeNO) values normalised (mean 38.7 to 19.3ppm) and mean Asthma Control Test values improved (13.1 to mean 17.8). Feedback from participants was positive. Overall the findings open up a new paradigm in device independent (can be used for any type of inhaler device) monitoring, providing a platform for evaluating / improving inhaler use at home.
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Affiliation(s)
- Michael D. Shields
- Centre for Infection and Immunity. School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Fahad ALQahtani
- Clinical and Practice Research Group, School of Pharmacy, Queen’s University of Belfast, Belfast, United Kingdom
| | - Michael P. Rivey
- Clinical and Practice Research Group, School of Pharmacy, Queen’s University of Belfast, Belfast, United Kingdom
- Department of Pharmacy Practice, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, Montana, United States of America
| | - James C. McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen’s University of Belfast, Belfast, United Kingdom
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Auten R, Ren C, Yilmaz O, Noah TL. Pediatric pulmonology year in review 2016: Part 2. Pediatr Pulmonol 2017; 52:1219-1225. [PMID: 28440920 PMCID: PMC7167696 DOI: 10.1002/ppul.23719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
Pediatric Pulmonology continues to publish research and clinical topics related to the entire range of children's respiratory disorders. As we have done annually in recent years, we here summarize some of the past year's publications in our major topic areas, as well as selected literature in these areas from other core journals relevant to our discipline. This review (Part 2) covers selected articles on neonatology, asthma, physiology and lung function testing, and infectious diseases.
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Affiliation(s)
| | - Clement Ren
- Department of Pediatrics, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Popov TA, Kralimarkova TZ, Labor M, Plavec D. The added value of exhaled breath temperature in respiratory medicine. J Breath Res 2017; 11:034001. [PMID: 28592704 DOI: 10.1088/1752-7163/aa7801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recognition of the huge economic burden chronic respiratory diseases pose for society motivated fundamental and clinical research leading to insight into the role of airway inflammation in various disease entities and their phenotypes. However, no easy, cheap and patient-friendly methods to assess it have found a place in routine clinical practice. Measurement of exhaled breath temperature (EBT) has been suggested as a non-invasive method to detect inflammatory processes in the airways as a result of increased blood flow within the airway walls. As EBT values are within a narrow range, the thermometers designed for the purpose of assessing it need to be precise and very sensitive. EBT increases linearly over the pediatric age range and seems to be influenced by gender, but not by height and body weight. In non-smoking individuals with no history of respiratory disease EBT has a natural circadian peak about noon and increases with food intake and physical exercise. When interpreting EBT in subjects with alleged airway pathology, the possibilities of tissue destruction (chronic obstructive pulmonary disease, cystic fibrosis) or excessive bronchial obstruction and air trapping (severe asthma) need to be considered, as these conditions drive (force) EBT down. A prominent advantage of the method is to assess EBT when patients are in a steady state of their disease and to use this 'personal best' to monitor them and guide their treatment. Individual devices outfitted with microprocessors and memory have been created, which can be used for personalized monitoring and disease management by telemedicine.
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Affiliation(s)
- Todor A Popov
- Clinic of Allergy and Asthma, Medical University Sofia, Bulgaria
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Wojsyk-Banaszak I, Mikoś M, Szczepankiewicz A, Wielebska A, Sobkowiak P, Kamińska A, Bręborowicz A. Evaluation of exhaled breath temperature (EBT) as a marker and predictor of asthma exacerbation in children and adolescents. J Asthma 2017; 54:699-705. [PMID: 28282228 DOI: 10.1080/02770903.2017.1290104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Noninvasive and easy-to-use tools to monitor airway inflammation in asthma are needed to maintain disease control, particularly in pediatric population. The aim of the study was to evaluate exhaled breath temperature (EBT) in pediatric respiratory clinic setting. METHODS We evaluated 37 children and adolescents with asthma (5-17 years; median: 11 years). The patients were followed up in stable condition and during exacerbations (paired observations in n = 19 subjects). We evaluated medication use, EBT, fractional exhaled nitric oxide (FeNO), spirometry and atopic status of patients. RESULTS EBT was significantly higher in children with asthma exacerbation {entire group: median [interquartile range (IQR)]: 32.3 [1.1]°C vs. 33.8 [1.7]°C; p < 0.001 and mean ± SD: 33.1 ± 1.0°C vs. 33.6 ± 1.1°C; p = 0.038 for paired observations}. Significant correlation was observed between EBT and FeNO in the entire group (r = 0.22; p = 0.03). No difference was observed in EBT median values in atopic and non-atopic subjects in the entire group (median [IQR]: 32.6 [1.6] vs. 32.7 [2.0]; p = 0.88) and in subgroups. There was no difference in EBT values in patients receiving systemic or inhaled glucocorticosteroids (p = 0.45 and 0.83). There was no significant correlation between EBT and body or room temperature. The only significant predictor of exacerbation in logistic regression model was EBT {aOR = 2.4; 95% [confidence interval (CI)]: 1.4-4.1}. ROC analysis demonstrated applicability of EBT as a marker of asthma exacerbation in children (AUC = 0.748; p < 0.001; cut-off = 33.3°C; sensitivity: 64.3%; specificity: 82.1%). CONCLUSIONS We suggest that EBT may serve as marker and predictor of asthma exacerbation in children. EBT follow-up may be useful in asthma monitoring in children and adolescents.
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Affiliation(s)
- Irena Wojsyk-Banaszak
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Marcin Mikoś
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Aleksandra Szczepankiewicz
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland.,b Laboratory of Molecular and Cell Biology, Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Alicja Wielebska
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Paulina Sobkowiak
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Aleksandra Kamińska
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
| | - Anna Bręborowicz
- a Department of Pneumonology, Pediatric Allergy and Clinical Immunology , Poznan University of Medical Sciences , Poznan , Poland
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Han MY. Could exhaled breath temperature discriminate the asthma? ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.3.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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