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Rousseau MC, Conus F, El-Zein M, Benedetti A, Parent ME. Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report. BMC Med Res Methodol 2023; 23:201. [PMID: 37679673 PMCID: PMC10486089 DOI: 10.1186/s12874-023-02011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources. METHODS We used administrative health data (1983-2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement. RESULTS Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52-0.63) to 0.67 (95% CI: 0.62-0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25-0.65 comparing ≥ 1 health services to none). CONCLUSIONS These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
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Affiliation(s)
- Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
- School of Public Health, Université de Montréal, Montréal, QC, Canada.
| | - Florence Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Direction des enquêtes de santé, Direction principale des statistiques sociales et de santé, Institut de la statistique du Québec, Montréal, QC, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- Division of Cancer Epidemiology, McGill University, Montréal, QC, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada
- School of Public Health, Université de Montréal, Montréal, QC, Canada
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Devani P, Lo DKH, Gaillard EA. Practical approaches to the diagnosis of asthma in school-age children. Expert Rev Respir Med 2022; 16:973-981. [PMID: 36125212 DOI: 10.1080/17476348.2022.2126355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Asthma is a chronic airways disease characterized by episodes of wheeze, chest tightness, and evidence of reversible airflow obstruction. Symptoms are frequently triggered by exercise, exposure to aeroallergens, and respiratory viruses. It is the commonest non-communicable respiratory condition in children, affecting over 5.5 million children in the European Union alone. Both over- and under- diagnosis of asthma are common for several reasons. AREAS COVERED The diagnosis is frequently based on parental or patient reported non-specific symptoms alone. All major asthma guidelines now recommend the use of objective tests, including spirometry, bronchodilator reversibility testing, fraction of exhaled nitric oxide measurements and challenge testing to confirm the diagnosis. Recently, the European Respiratory Society published the first evidence-based international guidelines for diagnosing asthma in school-age children using objective measures. Major barriers to implementation in primary care and less well-resourced healthcare settings are access to relevant objective tests for children and quality assurance to obtain reliable results. EXPERT OPINION We highlight the importance of diagnosing asthma in school-age children using objective tests and outline a practical approach for the use of widely available tests. We also review challenges and barriers to implementation of objective testing in children managed outside specialist settings.
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Affiliation(s)
- Pooja Devani
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
| | - David K H Lo
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK.,Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK.,Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
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3
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Sola-Martínez RA, Sanchez-Solis M, Lozano-Terol G, Gallego-Jara J, García-Marcos L, Cánovas Díaz M, de Diego Puente T. Relationship between lung function and exhaled volatile organic compounds in healthy infants. Pediatr Pulmonol 2022; 57:1282-1292. [PMID: 35092361 PMCID: PMC9304127 DOI: 10.1002/ppul.25849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study is to assess, for the first time, the relationship between the volatilome and lung function in healthy infants, which may be of help for the early detection of certain respiratory diseases. Lung function tests are crucial in chronic respiratory diseases diagnosis. Moreover, volatile organic compounds (VOCs) analysis in exhaled breath is a noninvasive technique that enables the monitorization of oxidative stress, typical of some forms of airway inflammation. METHODS Lung function was studied in 50 healthy infants of 3-8 months of age and the following parameters were obtained: forced vital capacity (FVC), forced expiratory volume at 0.5 s (FEV0.5 ), forced expiratory flow at 75% of FVC (FEF75 ), forced expiratory flow at 25%-75% of FVC (FEF25-75 ), and FEV0.5 /FVC. Lung function was measured according to the raised volume rapid thoracoabdominal compression technique. In addition, a targeted analysis of six endogenous VOCs (acetone, isoprene, decane, undecane, tetradecane, and pentadecane) in the exhaled breath of the children was carried out by means of thermal desorption coupled gas chromatography-single quadrupole mass spectrometry system. RESULTS A negatively significant relationship has been observed between levels of acetone, tetradecane, and pentadecane in exhaled breath and several of the lung function parameters. Levels of acetone (feature m/z = 58) were significantly negatively associated with FVC and FVE0.5 , levels of tetradecane (feature m/z = 71) with FEV0.5, and levels of pentadecane (feature m/z = 71) with FEV0.5 and FEF25-75 . CONCLUSION The findings of this study highlight a significant association between VOCs related to oxidative stress and lung function in healthy infants.
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Affiliation(s)
- Rosa A Sola-Martínez
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.,Group of Molecular Systems Biology, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Manuel Sanchez-Solis
- Group of Pediatric Research, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain.,Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain.,Network of Asthma and Adverse and Allergy Reactions (ARADyAL), Health Institute Carlos III, Madrid, Spain
| | - Gema Lozano-Terol
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.,Group of Molecular Systems Biology, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Julia Gallego-Jara
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.,Group of Molecular Systems Biology, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Luis García-Marcos
- Group of Pediatric Research, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain.,Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain.,Network of Asthma and Adverse and Allergy Reactions (ARADyAL), Health Institute Carlos III, Madrid, Spain
| | - Manuel Cánovas Díaz
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.,Group of Molecular Systems Biology, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Teresa de Diego Puente
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.,Group of Molecular Systems Biology, Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
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4
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Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, Rigau D, Ten Brinke A, Buhl R, Loukides S, Kocks JWH, Boulet LP, Bourdin A, Coleman C, Needham K, Thomas M, Idzko M, Papi A, Porsbjerg C, Schuermans D, Soriano JB, Usmani OS. European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. Eur Respir J 2022; 60:2101585. [PMID: 35169025 DOI: 10.1183/13993003.01585-2021] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV1/FVC ratio deserves further attention. The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.
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Affiliation(s)
- Renaud Louis
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
- First author, Task force chair
| | - Imran Satia
- McMaster University, Hamilton, Canada
- All authors contributed equally
| | - Inigo Ojanguren
- Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
- All authors contributed equally
| | - Florence Schleich
- Department of Pulmonary Medicine, University of Liege, Liège, Belgium
- All authors contributed equally
| | - Matteo Bonini
- Sapienza University of Rome, Rome, Italy
- All authors contributed equally
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Anne Ten Brinke
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | | | - Louis-Philippe Boulet
- Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada
| | | | | | | | - Mike Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Marco Idzko
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Celeste Porsbjerg
- Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark
| | - Daniel Schuermans
- Respiratory Division, Academic Hospital UZBrussel, Brussels, Belgium
| | - Joan B Soriano
- Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Omar S Usmani
- Asthma Lab, National Heart and Lung Institute, London, UK
- Corresponding author, Task force co-chair
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5
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Li JH, Han R, Wang YB, Cheng M, Chen HY, Lei WH, Li L, Gao C, Zhao NN, Nie NF, Li ZY, Yin GQ, Huang S, He Y. Diagnostic possibility of the combination of exhaled nitric oxide and blood eosinophil count for eosinophilic asthma. BMC Pulm Med 2021; 21:259. [PMID: 34372824 PMCID: PMC8351446 DOI: 10.1186/s12890-021-01626-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and it may be difficult for patients to cooperate. We aimed to evaluate whether the combination of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) can be used to distinguish some asthma patients who could avoid objective tests. METHODS We conducted a retrospective cohort study on 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Asthma was diagnosed by clinicians by the criteria of recurrent respiratory symptoms and a positive bronchial-provocation or bronchodilation test (BPT, BPD). We evaluated the diagnostic accuracy of FeNO or B-Eos alone or both in combination for asthma using receiver operating characteristic (ROC) curve analysis. RESULTS In this study, 824 patients were diagnosed with asthma. When FeNO and B-Eos counts were used in combination, the area under the ROC curve (AUC) for diagnosing asthma increased slightly (0.768 vs. 0.745 [FeNO] or 0.728 [B-Eos]; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001; assessed using the Cochran-Armitage trend test). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the 2017-2019 data as the internal validation dataset. CONCLUSION FeNO or B-Eos count alone is insufficient to accurately diagnose asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma and avoid objective tests when such tests are not feasible.
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Affiliation(s)
| | - Rui Han
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yu-Bo Wang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Min Cheng
- Department of Cardiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Heng-Yi Chen
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Wen-Hui Lei
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Chen Gao
- Department of Clinical Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Na-Na Zhao
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Nai-Fu Nie
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Zhong-Yan Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Guo-Qing Yin
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Shuai Huang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China.
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Sola-Martínez RA, Lozano-Terol G, Gallego-Jara J, Morales E, Cantero-Cano E, Sanchez-Solis M, García-Marcos L, Jiménez-Guerrero P, Noguera-Velasco JA, Cánovas Díaz M, de Diego Puente T. Exhaled volatilome analysis as a useful tool to discriminate asthma with other coexisting atopic diseases in women of childbearing age. Sci Rep 2021; 11:13823. [PMID: 34226570 PMCID: PMC8257728 DOI: 10.1038/s41598-021-92933-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of asthma is considerably high among women of childbearing age. Most asthmatic women also often have other atopic disorders. Therefore, the differentiation between patients with atopic diseases without asthma and asthmatics with coexisting diseases is essential to avoid underdiagnosis of asthma and to design strategies to reduce symptom severity and improve quality of life of patients. Hence, we aimed for the first time to conduct an analysis of volatile organic compounds in exhaled breath of women of childbearing age as a new approach to discriminate between asthmatics with other coexisting atopic diseases and non-asthmatics (with or without atopic diseases), which could be a helpful tool for more accurate asthma detection and monitoring using a noninvasive technique in the near future. In this study, exhaled air samples of 336 women (training set (n = 211) and validation set (n = 125)) were collected and analyzed by thermal desorption coupled with gas chromatography-mass spectrometry. ASCA (ANOVA (analysis of variance) simultaneous component analysis) and LASSO + LS (least absolute shrinkage and selection operator + logistic regression) were employed for data analysis. Fifteen statistically significant models (p-value < 0.05 in permutation tests) that discriminated asthma with other coexisting atopic diseases in women of childbearing age were generated. Acetone, 2-ethyl-1-hexanol and a tetrahydroisoquinoline derivative were selected as discriminants of asthma with other coexisting atopic diseases. In addition, carbon disulfide, a tetrahydroisoquinoline derivative, 2-ethyl-1-hexanol and decane discriminated asthma disease among patients with other atopic disorders. Results of this study indicate that refined metabolomic analysis of exhaled breath allows asthma with other coexisting atopic diseases discrimination in women of reproductive age.
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Affiliation(s)
- Rosa A Sola-Martínez
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Gema Lozano-Terol
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Julia Gallego-Jara
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Eva Morales
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
- Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | | | - Manuel Sanchez-Solis
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
- Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain
- Department of Paediatrics, University of Murcia, Murcia, Spain
- Network of Asthma and Adverse and Allergy Reactions (ARADyAL), Health Institute Carlos III, Madrid, Spain
| | - Luis García-Marcos
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
- Respiratory and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain
- Department of Paediatrics, University of Murcia, Murcia, Spain
- Network of Asthma and Adverse and Allergy Reactions (ARADyAL), Health Institute Carlos III, Madrid, Spain
| | - Pedro Jiménez-Guerrero
- Regional Atmospheric Modelling Group, Department of Physics, University of Murcia, Murcia, Spain
| | - José A Noguera-Velasco
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
- Molecular Therapy and Biomarkers Research Group, Clinical Analysis Service, University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Murcia, Spain
| | - Manuel Cánovas Díaz
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Teresa de Diego Puente
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia, Spain.
- Biomedical Research Institute of Murcia, IMIB-Arrixaca, Murcia, Spain.
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7
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Abstract
PURPOSE OF REVIEW Finding suitable biomarkers to phenotype asthma, identify individuals at risk of worsening and guide treatment is highly prioritized in asthma research. We aimed to provide an analysis of currently used and upcoming biomarkers, focusing on developments published in the past 2 years. RECENT FINDINGS Type 2 inflammation is the most studied asthma mechanism with the most biomarkers in the pipeline. Blood eosinophils and fractional exhaled nitric oxide (FeNO) are those most used clinically. Recent developments include their ability to identify individuals at higher risk of exacerbations, faster decline in lung function and more likely to benefit from anti-IL-5 and anti-IL-4/-13 treatment. Certain patterns of urinary eicosanoid excretion also relate to type 2 inflammation. Results of recent trials investigating the use of serum periostin or dipeptidyl peptidase-4 to guide anti-IL-13 therapy were somewhat disappointing. Less is known about non-type 2 inflammation but blood neutrophils and YKL-40 may be higher in patients with evidence of non-type 2 asthma. Volatile organic compounds show promise in their ability to distinguish both eosinophilic and neutrophilic asthma. SUMMARY The ultimate panel of biomarkers for identification of activated inflammatory pathways and treatment strategies in asthma patients still lies in the future, particularly for non-type 2 asthma, but potential candidates are available.
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8
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Sola Martínez RA, Pastor Hernández JM, Yanes Torrado Ó, Cánovas Díaz M, de Diego Puente T, Vinaixa Crevillent M. Exhaled volatile organic compounds analysis in clinical pediatrics: a systematic review. Pediatr Res 2021; 89:1352-1363. [PMID: 32919397 DOI: 10.1038/s41390-020-01116-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Measured exhaled volatile organic compounds (VOCs) in breath also referred to as exhaled volatilome have been long claimed as a potential source of non-invasive and clinically applicable biomarkers. However, the feasibility of using exhaled volatilome in clinical practice remains to be demonstrated, particularly in pediatrics where the need for improved non-invasive diagnostic and monitoring methods is most urgent. This work presents the first formal evidence-based judgment of the clinical potential of breath volatilome in the pediatric population. METHODS A rigorous systematic review across Web of Science, SCOPUS, and PubMed databases following the PRISMA statement guidelines. A narrative synthesis of the evidence was conducted and QUADAS-2 was used to assess the quality of selected studies. RESULTS Two independent reviewers deemed 22 out of the 229 records initially found to satisfy inclusion criteria. A summary of breath VOCs found to be relevant for several respiratory, infectious, and metabolic pathologies was conducted. In addition, we assessed their associated metabolism coverage through a functional characterization analysis. CONCLUSION Our results indicate that current research remains stagnant in a preclinical exploratory setting. Designing exploratory experiments in compliance with metabolomics practice should drive forward the clinical translation of VOCs breath analysis. IMPACT What is the key message of your article? Metabolomics practice could help to achieve the clinical utility of exhaled volatilome analysis. What does it add to the existing literature? This work is the first systematic review focused on disease status discrimination using analysis of exhaled breath in the pediatric population. A summary of the reported exhaled volatile organic compounds is conducted together with a functional characterization analysis. What is the impact? Having noted challenges preventing the clinical translation, we summary metabolomics practices and the experimental designs that are closer to clinical practice to create a framework to guide future trials.
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Affiliation(s)
- Rosa A Sola Martínez
- Department of Biochemistry and Molecular Biology (B) and Immunology, University of Murcia and Murcian Institute of Biosanitary Research Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - José M Pastor Hernández
- Department of Biochemistry and Molecular Biology (B) and Immunology, University of Murcia and Murcian Institute of Biosanitary Research Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Óscar Yanes Torrado
- Department of Electronic Engineering, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Metabolomics Platform, Reus, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Manuel Cánovas Díaz
- Department of Biochemistry and Molecular Biology (B) and Immunology, University of Murcia and Murcian Institute of Biosanitary Research Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Teresa de Diego Puente
- Department of Biochemistry and Molecular Biology (B) and Immunology, University of Murcia and Murcian Institute of Biosanitary Research Virgen de la Arrixaca (IMIB), Murcia, Spain.
| | - María Vinaixa Crevillent
- Department of Electronic Engineering, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Metabolomics Platform, Reus, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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9
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Sharma R, Zang W, Zhou M, Schafer N, Begley LA, Huang YJ, Fan X. Real Time Breath Analysis Using Portable Gas Chromatography for Adult Asthma Phenotypes. Metabolites 2021; 11:265. [PMID: 33922762 PMCID: PMC8145057 DOI: 10.3390/metabo11050265] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
Asthma is heterogeneous but accessible biomarkers to distinguish relevant phenotypes remain lacking, particularly in non-Type 2 (T2)-high asthma. Moreover, common clinical characteristics in both T2-high and T2-low asthma (e.g., atopy, obesity, inhaled steroid use) may confound interpretation of putative biomarkers and of underlying biology. This study aimed to identify volatile organic compounds (VOCs) in exhaled breath that distinguish not only asthmatic and non-asthmatic subjects, but also atopic non-asthmatic controls and also by variables that reflect clinical differences among asthmatic adults. A total of 73 participants (30 asthma, eight atopic non-asthma, and 35 non-asthma/non-atopic subjects) were recruited for this pilot study. A total of 79 breath samples were analyzed in real-time using an automated portable gas chromatography (GC) device developed in-house. GC-mass spectrometry was also used to identify the VOCs in breath. Machine learning, linear discriminant analysis, and principal component analysis were used to identify the biomarkers. Our results show that the portable GC was able to complete breath analysis in 30 min. A set of nine biomarkers distinguished asthma and non-asthma/non-atopic subjects, while sets of two and of four biomarkers, respectively, further distinguished asthmatic from atopic controls, and between atopic and non-atopic controls. Additional unique biomarkers were identified that discriminate subjects by blood eosinophil levels, obese status, inhaled corticosteroid treatment, and also acute upper respiratory illnesses within asthmatic groups. Our work demonstrates that breath VOC profiling can be a clinically accessible tool for asthma diagnosis and phenotyping. A portable GC system is a viable option for rapid assessment in asthma.
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Affiliation(s)
- Ruchi Sharma
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (R.S.); (W.Z.); (M.Z.)
| | - Wenzhe Zang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (R.S.); (W.Z.); (M.Z.)
| | - Menglian Zhou
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (R.S.); (W.Z.); (M.Z.)
| | - Nicole Schafer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (N.S.); (L.A.B.)
| | - Lesa A. Begley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (N.S.); (L.A.B.)
| | - Yvonne J. Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (N.S.); (L.A.B.)
| | - Xudong Fan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (R.S.); (W.Z.); (M.Z.)
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10
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Elenius V, Chawes B, Malmberg PL, Adamiec A, Ruszczyński M, Feleszko W, Jartti T. Lung function testing and inflammation markers for wheezing preschool children: A systematic review for the EAACI Clinical Practice Recommendations on Diagnostics of Preschool Wheeze. Pediatr Allergy Immunol 2021; 32:501-513. [PMID: 33222297 DOI: 10.1111/pai.13418] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Preschool wheeze is highly prevalent; 30%-50% of children have wheezed at least once before age six. Wheezing is not a disorder; it is a symptom of obstruction in the airways, and it is essential to identify the correct diagnosis behind this symptom. An increasing number of studies provide evidence for novel diagnostic tools for monitoring and predicting asthma in the pediatric population. Several techniques are available to measure airway obstruction and airway inflammation, including spirometry, impulse oscillometry, whole-body plethysmography, bronchial hyperresponsiveness test, multiple breath washout test, measurements of exhaled NO, and analyses of various other biomarkers. METHODS We systematically reviewed all the existing techniques available for measuring lung function and airway inflammation in preschool children to assess their potential and clinical value in the routine diagnostics and monitoring of airway obstruction. RESULTS If applicable, measuring FEV1 using spirometry is considered useful. For those unable to perform spirometry, whole-body plethysmography and IOS may be useful. Bronchial reversibility to beta2-agonist and hyperresponsiveness test with running exercise challenge may improve the sensitivity of these tests. CONCLUSIONS The difficulty of measuring lung function and the lack of large randomized controlled trials makes it difficult to establish guidelines for monitoring asthma in preschool children.
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Affiliation(s)
- Varpu Elenius
- Department of Pediatrics, Turku University Hospital and Turku University, Turku, Finland
| | - Bo Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pekka L Malmberg
- The Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | - Aleksander Adamiec
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland.,Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Ruszczyński
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tuomas Jartti
- Department of Pediatrics, University of Oulu and Oulu University Hospital, Oulu, Finland
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11
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Graff S, Zanella D, Stefanuto PH, Henket M, Paulus V, Guissard F, Moermans C, Van Steen K, Louis R, Schleich F. Are Volatile Organic Compounds Able to Identify Airflow Decline in Asthma? J Asthma Allergy 2021; 14:67-70. [PMID: 33531819 PMCID: PMC7846870 DOI: 10.2147/jaa.s289278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sophie Graff
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Delphine Zanella
- Organic and Biological Analytical Chemistry Group, University of Liege, Liege, Belgium
| | | | - Monique Henket
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Virginie Paulus
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Francoise Guissard
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Catherine Moermans
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | | | - Renaud Louis
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Florence Schleich
- Department of Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
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12
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Holden K, Makinde M, Wilde M, Richardson M, Coats T, Monks P, Gaillard EA. Assessing the feasibility and acceptability of online measurements of exhaled volatile organic compounds (VOCs) in children with preschool wheeze: a pilot study. BMJ Paediatr Open 2021; 5:e001003. [PMID: 34568587 PMCID: PMC8438855 DOI: 10.1136/bmjpo-2020-001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Investigating airway inflammation and pathology in wheezy preschool children is both technically and ethically challenging. Identifying and validating non-invasive tests would be a huge clinical advance. Real-time analysis of exhaled volatile organic compounds (VOCs) in adults is established, however, the feasibility of this non-invasive method in young children remains undetermined. AIM To determine the feasibility and acceptability of obtaining breath samples from preschool children by means of real-time mass spectrometry analysis of exhaled VOCs. METHODS Breath samples from preschool children were collected and analysed in real time by proton transfer reaction-time of flight-mass spectrometry (PTR-TOF-MS) capturing unique breath profiles. Acetone (mass channel m/z 59) was used as a reference profile to investigate the breath cycle in more detail. Dynamic time warping (DTW) was used to compare VOC profiles from adult breath to those we obtained in preschool children. RESULTS 16 children were recruited in the study, of which eight had acute doctor-diagnosed wheeze (mean (range) age 3.2 (1.9-4.5) years) and eight had no history of wheezing (age 3.3 (2.2-4.1) years). Fully analysable samples were obtained in 11 (68%). DTW was used to ascertain the distance between the time series of mass channel m/z 59 (acetone) and the other 193 channels. Commonality of 12 channels (15, 31, 33, 41, 43, 51, 53, 55, 57, 60, 63 and 77) was established between adult and preschool child samples despite differences in the breathing patterns. CONCLUSION Real-time measurement of exhaled VOCs by means of PTR-MS is feasible and acceptable in preschool children. Commonality in VOC profiles was found between adult and preschool children.
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Affiliation(s)
- Karl Holden
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK.,Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Misty Makinde
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK.,Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Michael Wilde
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Matthew Richardson
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK.,Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Paul Monks
- Department of Chemistry, University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Leicester NIHR Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK.,Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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13
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Data preprocessing workflow for exhaled breath analysis by GC/MS using open sources. Sci Rep 2020; 10:22008. [PMID: 33319832 PMCID: PMC7738550 DOI: 10.1038/s41598-020-79014-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
The noninvasive diagnosis and monitoring of high prevalence diseases such as cardiovascular diseases, cancers and chronic respiratory diseases are currently priority objectives in the area of health. In this regard, the analysis of volatile organic compounds (VOCs) has been identified as a potential noninvasive tool for the diagnosis and surveillance of several diseases. Despite the advantages of this strategy, it is not yet a routine clinical tool. The lack of reproducible protocols for each step of the biomarker discovery phase is an obstacle of the current state. Specifically, this issue is present at the data preprocessing step. Thus, an open source workflow for preprocessing the data obtained by the analysis of exhaled breath samples using gas chromatography coupled with single quadrupole mass spectrometry (GC/MS) is presented in this paper. This workflow is based on the connection of two approaches to transform raw data into a useful matrix for statistical analysis. Moreover, this workflow includes matching compounds from breath samples with a spectral library. Three free packages (xcms, cliqueMS and eRah) written in the language R are used for this purpose. Furthermore, this paper presents a suitable protocol for exhaled breath sample collection from infants under 2 years of age for GC/MS.
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14
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Reduced Exhaled Breath Condensate pH and Severity of Allergic Sensitization Predict School Age Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1570-1577. [PMID: 33186764 DOI: 10.1016/j.jaip.2020.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We previously reported that deaerated breath condensate pH (dEBC pH) can identify preschool children with recurrent wheezing at high asthma risk. OBJECTIVE To assess the ability of preschool dEBC pH to predict asthma risk at school age. METHODS Children of the baseline cohort were recontacted for follow-up. Asthma diagnosis at school age was evaluated according to Global Initiative for Asthma recommendations in 135 children who at baseline had been classified into the following groups: (asymptomatic) atopic wheezers (n = 30), (asymptomatic) nonatopic wheezers (n = 57), allergic rhinitis only (n = 14), and healthy controls (n = 34). RESULTS All (100%) former atopic wheezers, 12 (21%) of nonatopic wheezers, 2 (14%) of allergic rhinitis group, and 1 (3%) of healthy controls had developed asthma at follow-up. Among all children with baseline wheezing, baseline dEBC pH predicted asthma at follow-up with an area under the receiver operating characteristic curve (AUC) of 0.72 (sensitivity, 0.67; specificity, 0.76; at pH 7.83). Combining pH and Capacity class (CAP) led to substantial gain in sensitivity (0.96) and negative predictive value (NPV, 0.94). Additional clinical information (Asthma Predictive Index, family atopy, family asthma, and inhaled corticosteroids) further increased the potential to predict asthma (AUC, 0.94) and raised sensitivity (0.98) and NPV (0.97) to nearly perfect values. CONCLUSION Our findings suggest (1) that dEBC pH combined with CAP class may serve as highly sensitive, noninvasive marker for the early detection of young asymptomatic preschool children with increased asthma risk, and (2) the need for additional biomarkers with high specificity to optimize early risk stratification in this clinically challenging scenario.
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15
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Nekoee H, Graulich E, Schleich F, Guissard F, Paulus V, Henket M, Donneau AF, Louis R. Are type-2 biomarkers of any help in asthma diagnosis? ERJ Open Res 2020; 6:00169-2020. [PMID: 32714964 PMCID: PMC7369447 DOI: 10.1183/23120541.00169-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022] Open
Abstract
T2 biomarkers lack the accuracy to make an asthma diagnosis in patients with suggestive symptoms https://bit.ly/3hYnnHu.
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Affiliation(s)
- Haleh Nekoee
- Dept of Public Health, CHU Liege and University of Liege, Liege, Belgium
| | - Emmanuel Graulich
- Dept of Pneumology, CHU Liege and University of Liege, Liege, Belgium
| | - Florence Schleich
- Dept of Pneumology, CHU Liege and University of Liege, Liege, Belgium
| | | | - Virginie Paulus
- Dept of Pneumology, CHU Liege and University of Liege, Liege, Belgium
| | - Monique Henket
- Dept of Pneumology, CHU Liege and University of Liege, Liege, Belgium
| | | | - Renaud Louis
- Dept of Pneumology, CHU Liege and University of Liege, Liege, Belgium
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16
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Schleich FN, Zanella D, Stefanuto PH, Bessonov K, Smolinska A, Dallinga JW, Henket M, Paulus V, Guissard F, Graff S, Moermans C, Wouters EFM, Van Steen K, van Schooten FJ, Focant JF, Louis R. Exhaled Volatile Organic Compounds Are Able to Discriminate between Neutrophilic and Eosinophilic Asthma. Am J Respir Crit Care Med 2020; 200:444-453. [PMID: 30973757 DOI: 10.1164/rccm.201811-2210oc] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rationale: Analysis of exhaled breath for asthma phenotyping using endogenously generated volatile organic compounds (VOCs) offers the possibility of noninvasive diagnosis and therapeutic monitoring. Induced sputum is indeed not widely available and markers of neutrophilic asthma are still lacking.Objectives: To determine whether analysis of exhaled breath using endogenously generated VOCs can be a surrogate marker for recognition of sputum inflammatory phenotypes.Methods: We conducted a prospective study on 521 patients with asthma recruited from the University Asthma Clinic of Liege. Patients underwent VOC measurement, fraction of exhaled nitric oxide (FeNO) spirometry, sputum induction, and gave a blood sample. Subjects with asthma were classified in three inflammatory phenotypes according to their sputum granulocytic cell count.Measurements and Main Results: In the discovery study, seven potential biomarkers were highlighted by gas chromatography-mass spectrometry in a training cohort of 276 patients with asthma. In the replication study (n = 245), we confirmed four VOCs of interest to discriminate among asthma inflammatory phenotypes using comprehensive two-dimensional gas chromatography coupled to high-resolution time-of-flight mass spectrometry. Hexane and 2-hexanone were identified as compounds with the highest classification performance in eosinophilic asthma with accuracy comparable to that of blood eosinophils and FeNO. Moreover, the combination of FeNO, blood eosinophils, and VOCs gave a very good prediction of eosinophilic asthma (area under the receiver operating characteristic curve, 0.9). For neutrophilic asthma, the combination of nonanal, 1-propanol, and hexane had a classification performance similar to FeNO or blood eosinophils in eosinophilic asthma. Those compounds were found in higher levels in neutrophilic asthma.Conclusions: Our study is the first attempt to characterize VOCs according to sputum granulocytic profile in a large population of patients with asthma and provide surrogate markers for neutrophilic asthma.
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Affiliation(s)
| | | | | | - Kirill Bessonov
- 3Medical Genomics-BIO3, GIGA-R, University of Liege, Sart-Tilman, Liege, Belgium
| | - Agnieska Smolinska
- 4Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; and
| | - Jan W Dallinga
- 4Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; and
| | - Monique Henket
- 1Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | - Virginie Paulus
- 1Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | | | - Sophie Graff
- 1Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
| | | | - Emiel F M Wouters
- 5Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kristel Van Steen
- 3Medical Genomics-BIO3, GIGA-R, University of Liege, Sart-Tilman, Liege, Belgium
| | - Frederik-Jan van Schooten
- 4Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; and
| | | | - Renaud Louis
- 1Respiratory Medicine, GIGA I3, CHU Sart-Tilman, Liege, Belgium
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17
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Abstract
The diagnosis of asthma can be particularly difficult in young children, in whom wheezing is not always synonym with asthma. It is also difficult to predict which preschool children with wheeze will go on to be true asthmatics. In this chapter, we will characterize preschool wheezing and asthma and discuss early risk factors for the development of severe asthma. We will also review risk factors for severe acute wheezing in young children. Finally, we will describe the natural history and prognosis of wheezing and some of the attempts at early identification of children who will develop severe asthma.
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Affiliation(s)
- Erick Forno
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA USA
| | - Sejal Saglani
- Imperial College London, National Heart & Lung Institute, London, UK
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18
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Gobbi A, Gulotta C, Suki B, Mellano E, Pellegrino R, Brusasco V, Dellacà RL. Monitoring of respiratory resistance in the diagnosis of mild intermittent asthma. Clin Exp Allergy 2019; 49:921-923. [PMID: 30801802 DOI: 10.1111/cea.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/30/2019] [Accepted: 02/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alessandro Gobbi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.,Restech Srl, Milan, Italy
| | - Carlo Gulotta
- Dipartimento di Area Medica Specialistica, Malattie Apparato Respiratorio ad indirizzo Fisiopatologico, AOU San Luigi Gonzaga, Orbassano (Turin), Italy
| | - Béla Suki
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Enrico Mellano
- Dipartimento di Area Medica Specialistica, Malattie Apparato Respiratorio ad indirizzo Fisiopatologico, AOU San Luigi Gonzaga, Orbassano (Turin), Italy
| | | | - Vito Brusasco
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, Genoa, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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19
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Roth M, Stolz D. Biomarkers and personalised medicine for asthma. Eur Respir J 2019; 53:53/1/1802094. [PMID: 30606766 DOI: 10.1183/13993003.02094-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Michael Roth
- Pulmonary Care Division, Internal Medicine, University Hospital Basel, Basel, Switzerland.,Pulmonary Cell Research, Dept Biomedicine, University Basel, Basel, Switzerland
| | - Daiana Stolz
- Pulmonary Care Division, Internal Medicine, University Hospital Basel, Basel, Switzerland.,Pulmonary Cell Research, Dept Biomedicine, University Basel, Basel, Switzerland
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20
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Lee YJ, Fujisawa T, Kim CK. Biomarkers for Recurrent Wheezing and Asthma in Preschool Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:16-28. [PMID: 30479074 PMCID: PMC6267183 DOI: 10.4168/aair.2019.11.1.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 01/21/2023]
Abstract
Wheezing is one of the characteristic symptoms of asthma, but all preschool children with wheezing are not diagnosed with asthma. Preschool children are not cooperative enough to participate in spirometry and invasive tests. Thus, there is no conventional method to diagnose asthma in preschool children. We reviewed studies on non-invasive biomarkers for assessing asthma in preschool children. Specimens that can be easily obtained by non-invasive methods are blood, exhaled breath and urine. Eosinophils, eosinophil cationic protein and eosinophil-derived neurotoxin (EDN) in blood are helpful in evaluating eosinophilic inflammation of the airways. Exhaled breath contains nitric oxide, volatile organic compounds, various cytokines and mediators as analytical components. Fraction of exhaled nitric oxide has been used to assess the degree of eosinophil inflammation and has been standardized in school-age children and adults, but not yet in preschool children. Exhaled breath condensate (EBC) pH and various cytokines/mediators that are detected in EBC seem to be promising biomarkers for assessing asthma, but need more standardization and validation. There are several biomarkers useful for assessing asthma, but none are ideal. Some biomarkers need standardized methods of obtaining samples from uncooperative preschool children for clinical use and require sufficient validation. Recently, another activated eosinophil marker, serum EDN, has shown promising results as a biomarker for recurrent wheezing and asthma in preschool children.
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Affiliation(s)
- Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | | | - Chang Keun Kim
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea.,SKIMS-BIO Co., Ltd. Seoul, Korea.
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21
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Saglani S, Menzie-Gow AN. Approaches to Asthma Diagnosis in Children and Adults. Front Pediatr 2019; 7:148. [PMID: 31058123 PMCID: PMC6478800 DOI: 10.3389/fped.2019.00148] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/29/2019] [Indexed: 12/13/2022] Open
Abstract
Although the hallmark features of asthma include reversible airflow obstruction, airway eosinophilia, and symptoms of recurrent wheeze associated with breathlessness and cough, it is a heterogeneous disease. The extent of the pathophysiological abnormalities are variable between patients. Despite this, until recently, asthma diagnosis had been made very simplistically predominantly from a clinical history and examination, and often a trial of medication such as short acting bronchodilators. The limitations of this approach have become increasingly apparent with evidence of inappropriate over diagnosis, under diagnosis and misdiagnosis. Although there is no gold standard single test to make a diagnosis of asthma, there are several objective tests that can be used to support the diagnosis including physiological measures such as obstructive spirometry associated with bronchodilator reversibility and airway hyperresponsiveness. In addition, non-invasive tests of airway inflammation such as exhaled nitric oxide or peripheral blood eosinophils are important to identify those with an allergic or eosinophilic phenotype. Diagnostic guidelines reflect the importance of using objective tests to support a diagnosis of asthma, however practical application in the clinic may not be straightforward. The focus of this review is to discuss the need to undertake objective tests in all patients to support asthma diagnosis and not just rely on clinical features. The advantages, challenges and limitations of performing tests of lung function and airway inflammation in the clinic, the difficulties related to training and interpretation of results will be explored, and the utility and relevance of diagnostic tests will be compared in adults and children.
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Affiliation(s)
- Sejal Saglani
- National Heart & Lung Institute, Imperial College London, London, United Kingdom.,Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Andrew N Menzie-Gow
- National Heart & Lung Institute, Imperial College London, London, United Kingdom.,Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
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