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de Freitas Santi T, Barbosa B, Weber SH, Michelotto PV. Exhaled breath condensate analysis in horses: A scoping review. Res Vet Sci 2024; 168:105160. [PMID: 38278027 DOI: 10.1016/j.rvsc.2024.105160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
Exhaled breath condensate (EBC) collection is a non-invasive sampling method that provides valuable information regarding the health status of the respiratory system by measuring inflammatory mediators, such as pH, hydrogen peroxide, and leukotriene B4. This scoping review aimed to provide an update on the collection and analysis of EBC in horses. A systematic search of three electronic databases, PubMed, Google Scholar, Science Direct, identified 40,978 articles, of which 1590 duplicates were excluded. Moreover, 39,388 articles were excluded because of irrelevance to this review, such as studies on other species, studies on respiratory exhalation, reviews, and theses. Finally, we evaluated 14 articles in this review. Our review revealed significant differences in the collection, storage, and processing of EBC samples, emphasizing the need for standardizing the technique and using specific equipment to improve the interpretation of the results.
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Affiliation(s)
- Thasla de Freitas Santi
- Graduate Program in Animal Science, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, 80215-901 Curitiba, PR, Brazil
| | - Bianca Barbosa
- Graduate Program in Animal Science, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, 80215-901 Curitiba, PR, Brazil
| | - Saulo Henrique Weber
- Graduate Program in Animal Science, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, 80215-901 Curitiba, PR, Brazil
| | - Pedro Vicente Michelotto
- Graduate Program in Animal Science, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição 1155, Prado Velho, 80215-901 Curitiba, PR, Brazil.
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2
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Fireman Klein E, Yaacoby-Bianu K, Orlin I, Zetser A, Purits N, Livnat G. Exhaled Breath Condensate and Respiratory Sequelae in Children Post-COVID-19. Respiration 2023; 102:479-486. [PMID: 37393889 DOI: 10.1159/000530971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes an acute respiratory illness. A substantial proportion of adults experience persistent symptoms. There is a paucity of data on respiratory sequelae in children. Exhaled breath condensate (EBC) is a non-invasive tool used to assess airway inflammation. OBJECTIVES This study aimed to evaluate EBC parameters, respiratory, mental and physical ability among children post COVID-19 infection. METHODS Observational study of confirmed SARS-CoV-2 infection cases among children, aged 5-18 years, evaluated once, 1-6 months post positive SARS-CoV-2 PCR testing. All subjects performed spirometry, 6-min walk test (6MWT), EBC (pH, interleukin-6), and completed medical history questionnaires, Depression, Anxiety, and Stress Scale (DASS-21), and physical activity scores. Severity of COVID-19 disease was classified according to WHO criteria. RESULTS Fifty-eight children were included and classified asymptomatic (n = 14), mild (n = 37), and moderate (n = 7) disease. The asymptomatic group included younger patients compared to the mild and moderate groups (8.9 ± 2.5y vs. 12.3 ± 3.6y and 14.6 ± 2.5y, respectively, p = 0.001), as well as lower DASS-21 total scores (3.4 ± 4 vs. 8.7 ± 9.4 and 8.7 ± 0.6 respectively, p = 0.056), with higher scores in proximity to positive PCR (p = 0.011). No differences were found between the 3 groups regarding EBC, 6MWT, spirometry, body mass index percentile, and activity scores. CONCLUSIONS COVID-19 is an asymptomatic-mild disease in most young healthy children, with gradually diminishing emotional symptoms. Children without prolonged respiratory symptoms revealed no significant pulmonary sequelae as evaluated by EBC markers, spirometry, 6MWT, and activity scores. Larger studies are required to assess long-term pediatric consequences of post SARS-CoV-2 infection, to assess the need for pulmonology surveillance.
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Affiliation(s)
- Einat Fireman Klein
- Pulmonology division, Carmel Medical Center, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Karin Yaacoby-Bianu
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Pediatric Pulmonology unit, Carmel Medical Center, Haifa, Israel
| | - Ido Orlin
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Anna Zetser
- Chemistry Laboratory, Carmel Medical Center, Haifa, Israel
| | - Nona Purits
- Pediatric Pulmonology unit, Carmel Medical Center, Haifa, Israel
| | - Galit Livnat
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Pediatric Pulmonology unit, Carmel Medical Center, Haifa, Israel
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Portacci A, Pierucci P, Quaranta VN, Quaranta S, Iorillo I, Locorotondo C, Buonamico E, Dragonieri S, Carpagnano GE. A glimpse in post-COVID pathophysiology: the role of exhaled breath condensate pH as an early marker of residual alveolar inflammation. Expert Rev Respir Med 2022; 16:1093-1099. [PMID: 36170967 DOI: 10.1080/17476348.2022.2130764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND . Residual alveolar inflammation seems to be paramount in post-COVID pathophysiology. Currently, we still lack a reliable marker to detect and track alveolar phlogosis in these patients. Exhaled Breath Condensate (EBC) pH has robust evidences highlighting its correlation with lung phlogosis in various diseases. We aim to define the reliability of alveolar and bronchial EBC pH in the assessment and in the follow up of post-COVID related inflammation. RESEARCH DESIGN AND METHODS We enrolled 10 patients previously hospitalized due to COVID-19 pneumonia. We performed a complete follow-up after 3 months and 6 months from discharge. Each visit included routine blood tests, arterial blood gas analysis, 6-minute walking test, spirometry, diffusing capacity and body plethysmography. Finally, bronchial and alveolar EBC were collected at the end of each visit. RESULTS Alveolar EBC pH was significantly lower than bronchial EBC pH at T1. Moreover, alveolar EBC pH tended to be more acid after 3 months from hospital discharge compared to the same sample 6 months later. Serum inflammatory biomarkers showed no significant differences from T1 to T2. However, alveolar EBC pH was positively correlated with neutrophil-lymphocyte ratio. CONCLUSIONS Collecting EBC pH could help to understand pathophysiologic mechanism as well as monitoring alveolar inflammation in the post-COVID syndrome.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Paola Pierucci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | | | - Sara Quaranta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Ilaria Iorillo
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Cristian Locorotondo
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
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4
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Guo C, Lv S, Liu Y, Li Y. Biomarkers for the adverse effects on respiratory system health associated with atmospheric particulate matter exposure. JOURNAL OF HAZARDOUS MATERIALS 2022; 421:126760. [PMID: 34396970 DOI: 10.1016/j.jhazmat.2021.126760] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
Large amounts of epidemiological evidence have confirmed the atmospheric particulate matter (PM2.5) exposure was positively correlated with the morbidity and mortality of respiratory diseases. Nevertheless, its pathogenesis remains incompletely understood, probably resulting from the activation of oxidative stress, inflammation, altered genetic and epigenetic modifications in the lung upon PM2.5 exposure. Currently, biomarker investigations have been widely used in epidemiological and toxicological studies, which may help in understanding the biologic mechanisms underlying PM2.5-elicited adverse health outcomes. Here, the emerging biomarkers to indicate PM2.5-respiratory system interactions were summarized, primarily related to oxidative stress (ROS, MDA, GSH, etc.), inflammation (Interleukins, FENO, CC16, etc.), DNA damage (8-OHdG, γH2AX, OGG1) and also epigenetic modulation (DNA methylation, histone modification, microRNAs). The identified biomarkers shed light on PM2.5-elicited inflammation, fibrogenesis and carcinogenesis, thus may favor more precise interventions in public health. It is worth noting that some inconsistent findings may possibly relate to the inter-study differentials in the airborne PM2.5 sample, exposure mode and targeted subjects, as well as methodological issues. Further research, particularly by -omics technique to identify novel, specific biomarkers, is warranted to illuminate the causal relationship between PM2.5 pollution and deleterious lung outcomes.
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Affiliation(s)
- Caixia Guo
- Department of Occupational Health and Environmental Health, School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China
| | - Songqing Lv
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yufan Liu
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing 100069, China
| | - Yanbo Li
- Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing 100069, China; Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing 100069, China.
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5
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Oyer-Peterson K, Ruiz de Porras DG, Han I, Delclos GL, Brooks EG, Afshar M, Whitworth KW. A pilot study of total personal exposure to volatile organic compounds among Hispanic female domestic cleaners. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:1-11. [PMID: 34731075 PMCID: PMC8813894 DOI: 10.1080/15459624.2021.2000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cleaners have an elevated risk for the development or exacerbation of asthma and other respiratory conditions, possibly due to exposure to cleaning products containing volatile organic compounds (VOCs) leading to inflammation and oxidative stress. This pilot study aimed to quantify total personal exposure to VOCs and to assess biomarkers of inflammation and pulmonary oxidative stress in 15 predominantly Hispanic women working as domestic cleaners in San Antonio, Texas, between November 2019 and July 2020. In partnership with a community organization, Domésticas Unidas, recruited women were invited to attend a training session where they were provided 3M 3500 passive organic vapor monitors (badges) and began a 72-hr sampling period during which they were instructed to wear one badge during the entire period ("AT," for All the Time), a second badge only while they were inside their home ("INS," for INSide), and a third badge only when they were outside their home ("OUT," for OUTside). At the end of the sampling period, women returned the badges and provided blood and exhaled breath condensate (EBC) samples. From the badges, 30 individual VOCs were measured and summed to inform total VOC (TVOC) concentrations, as well as concentrations of the following VOC groups: aromatic hydrocarbons, alkanes, halogenated hydrocarbons, and terpenes. From the blood and EBC samples, concentrations of serum C-reactive protein (CRP) and EBC 8-isoprostane (8-ISP) and pH were quantified. Data analyses included descriptive statistics. The 72-hr average of personal exposure to TVOC was 34.4 ppb and ranged from 9.2 to 219.5 ppb. The most prevalent class of VOC exposures for most women (66.7%) was terpenes, specifically d-limonene. Overall, most women also experienced higher TVOC concentrations while outside their home (86.7%) as compared to inside their home. Serum CRP concentrations ranged from 0.3 to 20.3 mg/dL; 8-ISP concentrations ranged from 9.5 to 44.1 pg/mL; and EBC pH ranged from 7.1 to 8.6. Overall, this pilot study demonstrated personal VOC exposure among Hispanic domestic cleaners, particularly to d-limonene, which may result from the use of scented cleaning products.
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Affiliation(s)
- Kelly Oyer-Peterson
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX, USA
- CIBER Epidemiología y Salud Pública, Madrid, 28029, Spain
- Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona, 08003, Spain
| | - Inkyu Han
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - George L. Delclos
- CIBER Epidemiología y Salud Pública, Madrid, 28029, Spain
- Center for Research in Occupational Health (CISAL), Universitat Pompeu Fabra, Barcelona, 08003, Spain
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Edward G. Brooks
- The University of Texas Health Science Center at San Antonio (UT Health San Antonio), Long School of Medicine, Department of Microbiology, Immunology & Molecular Genetics, San Antonio, TX, USA
| | - Masoud Afshar
- Southwest Center for Occupational and Environmental Health (SWCOEH), Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Kristina W. Whitworth
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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6
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Rama TA, Paciência I, Cavaleiro Rufo J, Silva D, Cunha P, Severo M, Padrão P, Moreira P, Delgado L, Moreira A. Exhaled breath condensate pH determinants in school-aged children: A population-based study. Pediatr Allergy Immunol 2021; 32:1474-1481. [PMID: 34018256 DOI: 10.1111/pai.13564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exhaled breath condensate (EBC) pH is a promising biomarker of airway inflammation. Lack of method standardization and interstudy variability precludes its use in clinical practice. While endogenous determinants have been described, underlying mechanisms for variability are mostly unknown. Thus, we aimed to assess the association between asthma and EBC pH in children, while studying potential environmental factors for interstudy variability. METHODS A cross-sectional analysis of exhaled breath condensates from 613 children, aged 7-12 years, was conducted. Assessments included lung function and airway reversibility, exhaled nitric oxide, allergic sensitization, and body mass index (BMI). Indoor air quality (IAQ) was assessed in children's classrooms during 5 school days. Post-deaeration EBC pH showed a bimodal distribution, and the sample was split into acidic and alkaline groups. Regression models were constructed to assess the effects of asthma and asthma adjusted to IAQ parameters on EBC pH. RESULTS Following adjustment to gender and BMI, asthma was significantly associated with a lower EBC pH in the acidic group. The effect of asthma on EBC pH was independent of IAQ, in both groups. In the acidic group, EBC pH was significantly affected by temperature [β = -0.09 (-0.15, -0.02)] and PM 2.5 concentration [β = -0.16 (-0.32, -0.01)], and in the alkaline group by relative humidity [β = 0.07 (0.02, 0.13)] and concentration of endotoxins [β = -0.06 (-0.1, -0.01)]. CONCLUSION Our study shows that in addition to individual determinants such as asthma, environmental factors may influence and should be taken into consideration when interpreting EBC pH level in children.
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Affiliation(s)
- Tiago Azenha Rama
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - Diana Silva
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Cunha
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Milton Severo
- Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Luís Delgado
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André Moreira
- Immunoallergology unit, Centro Hospitalar Universitário São João, Porto, Portugal.,Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health (EPIUnit), University of Porto, Porto, Portugal
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7
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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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8
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Zimmerman K, Kearns F, Tzekov R. Natural protection of ocular surface from viral infections - A hypothesis. Med Hypotheses 2020; 143:110082. [PMID: 32679424 PMCID: PMC7346787 DOI: 10.1016/j.mehy.2020.110082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/04/2020] [Indexed: 01/08/2023]
Abstract
A pandemic outbreak of a viral respiratory infection (COVID-19) caused by a coronavirus (SARS-CoV-2) prompted a multitude of research focused on various aspects of this disease. One of the interesting aspects of the clinical manifestation of the infection is an accompanying ocular surface viral infection, viral conjunctivitis. Although occasional reports of viral conjunctivitis caused by this and the related SARS-CoV virus (causing the SARS outbreak in the early 2000s) are available, the prevalence of this complication among infected people appears low (~1%). This is surprising, considering the recent discovery of the presence of viral receptors (ACE2 and TMPRSS2) in ocular surface tissue. The discrepancy between the theoretically expected high rate of concurrence of viral ocular surface inflammation and the observed relatively low occurrence can be explained by several factors. In this work, we discuss the significance of natural protective factors related to anatomical and physiological properties of the eyes and preventing the deposition of large number of virus-loaded particles on the ocular surface. Specifically, we advance the hypothesis that the standing potential of the eye plays an important role in repelling aerosol particles (microdroplets) from the surface of the eye and discuss factors associated with this hypothesis, possible ways to test it and its implications in terms of prevention of ocular infections.
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Affiliation(s)
- Keith Zimmerman
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA
| | - Fiona Kearns
- Department of Chemistry, University of South Florida, Tampa, FL, USA
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, FL, USA; Department of Pharmaceutical Sciences, University of South Florida, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA.
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9
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Maier D, Laubender E, Basavanna A, Schumann S, Güder F, Urban GA, Dincer C. Toward Continuous Monitoring of Breath Biochemistry: A Paper-Based Wearable Sensor for Real-Time Hydrogen Peroxide Measurement in Simulated Breath. ACS Sens 2019; 4:2945-2951. [PMID: 31610653 PMCID: PMC6879172 DOI: 10.1021/acssensors.9b01403] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/15/2019] [Indexed: 11/28/2022]
Abstract
Exhaled breath contains a large amount of biochemical and physiological information concerning one's health and provides an alternative route to noninvasive medical diagnosis of diseases. In the case of lung diseases, hydrogen peroxide (H2O2) is an important biomarker associated with asthma, chronic obstructive pulmonary disease, and lung cancer and can be detected in exhaled breath. The current method of breath analysis involves condensation of exhaled breath, is not continuous or real time, and requires two separate and bulky devices, complicating the periodic or long-term monitoring of a patient. We report the first disposable paper-based electrochemical wearable sensor that can monitor exhaled H2O2 in artificial breath calibration-free and continuously, in real time, and can be integrated into a commercial respiratory mask for on-site testing of exhaled breath. To improve precision for sensing H2O2, we perform differential electrochemical measurement by amperometry in which screen-printed Prussian Blue-mediated and nonmediated carbon electrodes are used for differential analysis. We were able to measure H2O2 in simulated breath in a concentration-dependent manner in real time, confirming its functionality. This proposed system is versatile, and by modifying the chemistry of the sensing electrodes, our method of differential sensing can be extended to continuous monitoring of other analytes in exhaled breath.
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Affiliation(s)
- Daniela Maier
- Department
of Microsystems Engineering (IMTEK), Laboratory for Sensors and Freiburg Center
for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, 79110 Freiburg, Germany
| | - Elmar Laubender
- Department
of Microsystems Engineering (IMTEK), Laboratory for Sensors and Freiburg Center
for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, 79110 Freiburg, Germany
| | - Abhiraj Basavanna
- Department
of Microsystems Engineering (IMTEK), Laboratory for Sensors and Freiburg Center
for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, 79110 Freiburg, Germany
| | - Stefan Schumann
- Department
of Anesthesiology and Critical Care, Medical Center—University
of Freiburg, Faculty of Medicine, University
of Freiburg, 79106 Freiburg, Germany
| | - Firat Güder
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, Great Britain, U.K.
| | - Gerald A. Urban
- Department
of Microsystems Engineering (IMTEK), Laboratory for Sensors and Freiburg Center
for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, 79110 Freiburg, Germany
- Freiburg
Materials Research Center (FMF), University
of Freiburg, 79104 Freiburg, Germany
| | - Can Dincer
- Department
of Microsystems Engineering (IMTEK), Laboratory for Sensors and Freiburg Center
for Interactive Materials and Bioinspired Technologies (FIT), University of Freiburg, 79110 Freiburg, Germany
- Department
of Bioengineering, Imperial College London, London SW7 2AZ, Great Britain, U.K.
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10
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Finamore P, Scarlata S, Cardaci V, Incalzi RA. Exhaled Breath Analysis in Obstructive Sleep Apnea Syndrome: A Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E538. [PMID: 31461988 PMCID: PMC6780099 DOI: 10.3390/medicina55090538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Obstructive sleep apnea syndrome (OSAS) represents an independent risk factor for cardiovascular, metabolic and neurological events. Polysomnography is the gold-standard for the diagnosis, however is expensive and time-consuming and not suitable for widespread use. Breath analysis is an innovative, non-invasive technique, able to provide clinically relevant information about OSAS. This systematic review was aimed to outline available evidence on the role of exhaled breath analysis in OSAS, taking into account the techniques' level of adherence to the recently proposed technical standards. Materials and Methods: Articles reporting original data on exhaled breath analysis in OSAS were identified through a computerized and manual literature search and screened. Duplicate publications, case reports, case series, conference papers, expert opinions, comments, reviews and meta-analysis were excluded. Results: Fractional exhaled Nitric Oxide (FeNO) is higher in OSAS patients than controls, however its absolute value is within reported normal ranges. FeNO association with AHI is controversial, as well as its change after continuous positive airway pressure (C-PAP) therapy. Exhaled breath condensate (EBC) is acid in OSAS, cytokines and oxidative stress markers are elevated, they positively correlate with AHI and normalize after treatment. The analysis of volatile organic compounds (VOCs) by spectrometry or electronic nose is able to discriminate OSAS from healthy controls. The main technical issues regards the dilution of EBC and the lack of external validation in VOCs studies. Conclusions: Exhaled breath analysis has a promising role in the understanding of mechanisms underpinning OSAS and has demonstrated a clinical relevance in identifying individuals affected by the disease, in assessing the response to treatment and, potentially, to monitor patient's adherence to mechanical ventilation. Albeit the majority of the technical standards proposed by the ERS committee have been followed by existing papers, further work is needed to uniform the methodology.
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Affiliation(s)
- Panaiotis Finamore
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Simone Scarlata
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy.
| | - Vittorio Cardaci
- Pulmonary Rehabilitation, IRCCS San Raffaele Pisana, 00166 Rome, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Campus Bio-Medico di Roma University, via Alvaro del Portillo 200, 00128 Rome, Italy
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11
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Qiu J, Ishizuka S, Tonokura K, Sato K, Inomata S, Enami S. Effects of pH on Interfacial Ozonolysis of α-Terpineol. J Phys Chem A 2019; 123:7148-7155. [PMID: 31329444 DOI: 10.1021/acs.jpca.9b05434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acidity changes the physical properties of atmospheric aerosol particles and the mechanisms of reactions that occur therein and on the surface. Here, we used surface-sensitive pneumatic ionization mass spectrometry to investigate the effects of pH on the heterogeneous reactions of aqueous α-terpineol (C10H17OH), a representative monoterpene alcohol, with gaseous ozone. Rapid (≤10 μs) ozonolysis of α-terpineol produced Criegee intermediates (CIs, zwitterionic/diradical carbonyl oxides) on the surface of water microjets. We studied the effects of microjet bulk pH (1-11) on the formation of functionalized carboxylate and α-hydroxy-hydroperoxide chloride adduct (HH-Cl-) products generated by isomerization and hydration of α-terpineol CIs, respectively. Compared with the signal at pH ≈ 6, the mass spectral signal of HH-Cl- was less intense under both basic and more acidic conditions, whereas the intensity of the functionalized carboxylate signal increased with increasing pH up to 4 and then remained constant. The decrease of HH-Cl- signals at bulk pH values of >6 is attributable to the accumulation of OH- at the air-water interface that suppresses the relative abundance of hydrophilic HH and Cl-. The present study suggests that α-terpineol in ambient aqueous organic aerosols will be converted into much lower volatile and potentially toxic organic hydroperoxides during the heterogeneous ozonolysis.
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Affiliation(s)
- Junting Qiu
- Graduate School of Frontier Sciences , The University of Tokyo , 5-1-5 Kashiwanoha , Kashiwa 277-8563 , Japan
| | - Shinnosuke Ishizuka
- National Institute for Environmental Studies , 16-2 Onogawa , Tsukuba 305-8506 , Japan
| | - Kenichi Tonokura
- Graduate School of Frontier Sciences , The University of Tokyo , 5-1-5 Kashiwanoha , Kashiwa 277-8563 , Japan
| | - Kei Sato
- National Institute for Environmental Studies , 16-2 Onogawa , Tsukuba 305-8506 , Japan
| | - Satoshi Inomata
- National Institute for Environmental Studies , 16-2 Onogawa , Tsukuba 305-8506 , Japan
| | - Shinichi Enami
- National Institute for Environmental Studies , 16-2 Onogawa , Tsukuba 305-8506 , Japan
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12
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Abstract
Exhaled breath condensate (EBC) is a promising source of biomarkers of lung disease. EBC research and utility has increased substantially over the past 2 decades. This review summarizes many of the factors regarding the composition of EBC, its collection, and analysis for the utility of both clinicians and researchers.
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Affiliation(s)
- Michael D Davis
- Division of Pulmonary Medicine, Children's Hospital of Richmond at VCU, Hermes A. Kontos Medical Sciences Building, Room 215, 1217 East Marshall Street, Richmond, VA 23298, USA.
| | - Alison J Montpetit
- VCU Medical Center, Department of Emergency Medicine, Box 980401, Richmond, VA 23298-0401, USA
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13
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Araneda OF, Contreras-Briceño F, Cavada G, Viscor G. Swimming versus running: effects on exhaled breath condensate pro-oxidants and pH. Eur J Appl Physiol 2018; 118:2319-2329. [PMID: 30094648 DOI: 10.1007/s00421-018-3958-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The respiratory redox-state of swimmers can be affected by chronic exposures to chlorinated pools, and the effects of different exercises on it are unknown. Our aim was to compare two exercises performed at high-intensity and under habitual environmental conditions (swimming indoor vs. running outdoor) on the production of pro-oxidants (hydrogen peroxide and nitrite) and pH in exhaled breath condensate (EBC) and spirometry parameters in competitive swimmers chronically exposed to chlorinated pools. METHODS Seventeen men and women (mean age ± SD = 21 ± 2 years) swam 3.5 km in an indoor pool treated with Cl2, and after 2-weeks, they ran 10 km outdoors. The pHEBC, [H2O2]EBC, [NO2-]EBC, [NO2-]EBC/[NO2-]Plasma and spirometry parameters were analyzed pre-exercise and 20 min and 24 h after exercise ended. RESULTS Two mixed models were applied to compare EBC parameters between swimming and running. Lower levels of [H2O2]EBC and [NO2-]EBC (p = 0.008 and p = 0.018, respectively) were found 24-h post-swimming, and the same trend was observed for [NO2-]EBC/[NO2-]Plasma (p = 0.062). Correlations were found in both exercises between pre-exercise levels of pHEBC, [H2O2]EBC, [NO2-]EBC, and [NO2-]EBC/[NO2-]Plasma and their changes (Δ) after 24-h as well as between [H2O2]EBC and [NO2-]EBC for basal levels and for changes after 24 h. A relationship was also found for running exercise between pulmonary ventilation and changes after 24 h in [H2O2]EBC. Spirometry data were unaffected in both types of exercise. CONCLUSION In competitive swimmers, at 24-h acute post-exercise follow-up, swimming decreased and running increased pro-oxidant biomarkers of pulmonary origin, without changes in lung function.
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Affiliation(s)
- Oscar F Araneda
- Laboratorio de Fisiología Integrativo de Biomecánica y Fisiología Integrativa (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile.
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health of Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Gabriel Cavada
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
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14
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Tenero L, Zaffanello M, Piazza M, Piacentini G. Measuring Airway Inflammation in Asthmatic Children. Front Pediatr 2018; 6:196. [PMID: 30035104 PMCID: PMC6043865 DOI: 10.3389/fped.2018.00196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022] Open
Abstract
Asthma is the most common chronic respiratory disease in children characterized by airways inflammation, bronchial hyperresponsiveness, recurrent reversible airways obstruction, and respiratory symptoms. The diagnosis of the disease is based on clinical history, airways obstruction at spirometry, and bronchial reversibility. Asthma treatment is aimed to disease control, through the use of controller treatment and monitoring lung function. However, lung function and symptoms not always reflect the underlying airways inflammation and response to the therapy. Objective parameters of asthma inflammation could be important for the clinician in the management of patients with asthma. In the last years, some studies were focused on biomarkers to identify phenotype, inflammation, and pathobiological pathways to help the clinician in the diagnosis and in personalizing the management. Accordingly, clinically feasible tests are represented by the collection of exhaled breath condensate (EBC) and measurement of exhaled nitric oxide (FeNO). Other-methods such as the evaluation of volatile organic compound (VOCs), that reflect airways inflammation and treatment efficacy, are currently used for research purposes For some of these methods, The lack of standardization in pre-collection, collection, post-collection of samples, and interpretation of the results may a problem in clinical practice. Improved these limitations, several biomarkers will be useful to distinguish patients with a different disease condition to personalize the treatment.
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Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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15
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Shiraiwa M, Ueda K, Pozzer A, Lammel G, Kampf CJ, Fushimi A, Enami S, Arangio AM, Fröhlich-Nowoisky J, Fujitani Y, Furuyama A, Lakey PSJ, Lelieveld J, Lucas K, Morino Y, Pöschl U, Takahama S, Takami A, Tong H, Weber B, Yoshino A, Sato K. Aerosol Health Effects from Molecular to Global Scales. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:13545-13567. [PMID: 29111690 DOI: 10.1021/acs.est.7b04417] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Poor air quality is globally the largest environmental health risk. Epidemiological studies have uncovered clear relationships of gaseous pollutants and particulate matter (PM) with adverse health outcomes, including mortality by cardiovascular and respiratory diseases. Studies of health impacts by aerosols are highly multidisciplinary with a broad range of scales in space and time. We assess recent advances and future challenges regarding aerosol effects on health from molecular to global scales through epidemiological studies, field measurements, health-related properties of PM, and multiphase interactions of oxidants and PM upon respiratory deposition. Global modeling combined with epidemiological exposure-response functions indicates that ambient air pollution causes more than four million premature deaths per year. Epidemiological studies usually refer to PM mass concentrations, but some health effects may relate to specific constituents such as bioaerosols, polycyclic aromatic compounds, and transition metals. Various analytical techniques and cellular and molecular assays are applied to assess the redox activity of PM and the formation of reactive oxygen species. Multiphase chemical interactions of lung antioxidants with atmospheric pollutants are crucial to the mechanistic and molecular understanding of oxidative stress upon respiratory deposition. The role of distinct PM components in health impacts and mortality needs to be clarified by integrated research on various spatiotemporal scales for better evaluation and mitigation of aerosol effects on public health in the Anthropocene.
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Affiliation(s)
- Manabu Shiraiwa
- Department of Chemistry, University of California , Irvine, California 92697, United States
| | - Kayo Ueda
- Kyoto University , Kyoto 606-8501, Japan
| | | | - Gerhard Lammel
- Research Centre for Toxic Compounds in the Environment, Masaryk University , 625 00 Brno, Czech Republic
| | - Christopher J Kampf
- Institute for Organic Chemistry, Johannes Gutenberg University , 55122 Mainz, Germany
| | - Akihiro Fushimi
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | - Shinichi Enami
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | - Andrea M Arangio
- Swiss Federal Institute of Technology in Lausanne (EPFL) , Lausanne 1015, Switzerland
| | | | - Yuji Fujitani
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | - Akiko Furuyama
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | - Pascale S J Lakey
- Department of Chemistry, University of California , Irvine, California 92697, United States
| | | | | | - Yu Morino
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | | | - Satoshi Takahama
- Swiss Federal Institute of Technology in Lausanne (EPFL) , Lausanne 1015, Switzerland
| | - Akinori Takami
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | | | | | - Ayako Yoshino
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
| | - Kei Sato
- National Institute for Environmental Studies , Tsukuba 305-8506, Japan
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16
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Winters BR, Pleil JD, Angrish MM, Stiegel MA, Risby TH, Madden MC. Standardization of the collection of exhaled breath condensate and exhaled breath aerosol using a feedback regulated sampling device. J Breath Res 2017; 11:047107. [PMID: 28894051 DOI: 10.1088/1752-7163/aa8bbc] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Exhaled breath condensate (EBC) and associated exhaled breath aerosols (EBA) are valuable non-invasive biological media used for the quantification of biomarkers. EBC contains exhaled water vapor, soluble gas-phase (polar) organic compounds, ionic species, plus other species including semi- and non-volatile organic compounds, proteins, cell fragments, DNA, dissolved inorganic compounds, ions, and microbiota (bacteria and viruses) dissolved in the co-collected EBA. EBC is collected from subjects who breathe 'normally' through a chilled tube assembly for approximately 10 min and is then harvested into small vials for analysis. Aerosol filters without the chilled tube assembly are also used to separately collect EBA. Unlike typical gas-phase breath samples used for environmental and clinical applications, the constituents of EBC and EBA are not easily characterized by total volume or carbon dioxide (CO2) concentration, because the gas-phase is vented. Furthermore, EBC and associated EBA are greatly affected by breathing protocol, more specifically, depth of inhalation and expelled breath velocity. We have tested a new instrument developed by Loccioni Gruppa Humancare (Ancona, Italy) for implementation of EBC collection from human subjects to assess EBC collection parameters. The instrument is the first EBC collection device that provides instantaneous visual feedback to the subjects to control breathing patterns. In this report we describe the operation of the instrument, and present an overview of performance and analytical applications.
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Affiliation(s)
- Brett R Winters
- Curriculum in Toxicology, University of North Carolina, Chapel Hill, NC, United States of America
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17
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Altemose B, Robson MG, Kipen HM, Ohman Strickland P, Meng Q, Gong J, Huang W, Wang G, Rich DQ, Zhu T, Zhang J. Association of air pollution sources and aldehydes with biomarkers of blood coagulation, pulmonary inflammation, and systemic oxidative stress. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:244-250. [PMID: 27436693 DOI: 10.1038/jes.2016.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Abstract
Using data collected before, during, and after the 2008 Summer Olympic Games in Beijing, this study examines associations between biomarkers of blood coagulation (vWF, sCD62P and sCD40L), pulmonary inflammation (EBC pH, EBC nitrite, and eNO), and systemic oxidative stress (urinary 8-OHdG) with sources of air pollution identified utilizing principal component analysis and with concentrations of three aldehydes of health concern. Associations between the biomarkers and the air pollution source types and aldehydes were examined using a linear mixed effects model, regressing through seven lag days and controlling for ambient temperature, relative humidity, gender, and day of week for the biomarker measurements. The biomarkers for pulmonary inflammation, particularly EBC pH and eNO, were most consistently associated with vehicle and industrial combustion, oil combustion, and vegetative burning. The biomarkers for blood coagulation, particularly vWF and sCD62p, were most consistently associated with oil combustion. Systemic oxidative stress biomarker (8-OHdG) was most consistently associated with vehicle and industrial combustion. The associations of the biomarkers were generally not significant or consistent with secondary formation of pollutants and with the aldehydes. The findings support policies to control anthropogenic pollution sources rather than natural soil or road dust from a cardio-respiratory health standpoint.
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Affiliation(s)
- Brent Altemose
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Mark G Robson
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Howard M Kipen
- Environmental and Occupational Sciences Institute (EOHSI), Rutgers University, Piscataway, New Jersey, USA
| | | | - Qingyu Meng
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Jicheng Gong
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Wei Huang
- State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Guangfa Wang
- Department of Pulmonary Medicine, Peking University First Hospital, Beijing, China
| | - David Q Rich
- School of Medicine and Dentistry, Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Tong Zhu
- State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Junfeng Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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18
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Horváth I, Barnes PJ, Loukides S, Sterk PJ, Högman M, Olin AC, Amann A, Antus B, Baraldi E, Bikov A, Boots AW, Bos LD, Brinkman P, Bucca C, Carpagnano GE, Corradi M, Cristescu S, de Jongste JC, Dinh-Xuan AT, Dompeling E, Fens N, Fowler S, Hohlfeld JM, Holz O, Jöbsis Q, Van De Kant K, Knobel HH, Kostikas K, Lehtimäki L, Lundberg J, Montuschi P, Van Muylem A, Pennazza G, Reinhold P, Ricciardolo FLM, Rosias P, Santonico M, van der Schee MP, van Schooten FJ, Spanevello A, Tonia T, Vink TJ. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J 2017; 49:49/4/1600965. [PMID: 28446552 DOI: 10.1183/13993003.00965-2016] [Citation(s) in RCA: 375] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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Affiliation(s)
- Ildiko Horváth
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/Gävleborg County Council, Gävle, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Goteborg, Sweden
| | - Anton Amann
- Innsbruck Medical University, Innsbruck, Austria
| | - Balazs Antus
- Dept of Pathophysiology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Andras Bikov
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, University of Maastricht, Maastricht, The Netherlands
| | - Lieuwe D Bos
- Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina Bucca
- Biomedical Sciences and Human Oncology, Universita' di Torino, Turin, Italy
| | | | | | - Simona Cristescu
- Dept of Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics/Respiratory Medicine, Erasmus MC-Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | | | - Edward Dompeling
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niki Fens
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Fowler
- Respiratory Research Group, University of Manchester Wythenshawe Hospital, Manchester, UK
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Medizinische Hochschule Hannover, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim Van De Kant
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hugo H Knobel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | | | | | - Jon Lundberg
- Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alain Van Muylem
- Hopital Erasme Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Giorgio Pennazza
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Petra Reinhold
- Institute of Molecular Pathogenesis, Friedrich Loeffler Institut, Jena, Germany
| | - Fabio L M Ricciardolo
- Clinic of Respiratory Disease, Dept of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Philippe Rosias
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Pediatrics, Maasland Hospital, Sittard, The Netherlands
| | - Marco Santonico
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Marc P van der Schee
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Thomy Tonia
- European Respiratory Society, Lausanne, Switzerland
| | - Teunis J Vink
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
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19
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Reinmuth-Selzle K, Kampf CJ, Lucas K, Lang-Yona N, Fröhlich-Nowoisky J, Shiraiwa M, Lakey PSJ, Lai S, Liu F, Kunert AT, Ziegler K, Shen F, Sgarbanti R, Weber B, Bellinghausen I, Saloga J, Weller MG, Duschl A, Schuppan D, Pöschl U. Air Pollution and Climate Change Effects on Allergies in the Anthropocene: Abundance, Interaction, and Modification of Allergens and Adjuvants. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:4119-4141. [PMID: 28326768 PMCID: PMC5453620 DOI: 10.1021/acs.est.6b04908] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/07/2017] [Accepted: 03/22/2017] [Indexed: 05/13/2023]
Abstract
Air pollution and climate change are potential drivers for the increasing burden of allergic diseases. The molecular mechanisms by which air pollutants and climate parameters may influence allergic diseases, however, are complex and elusive. This article provides an overview of physical, chemical and biological interactions between air pollution, climate change, allergens, adjuvants and the immune system, addressing how these interactions may promote the development of allergies. We reviewed and synthesized key findings from atmospheric, climate, and biomedical research. The current state of knowledge, open questions, and future research perspectives are outlined and discussed. The Anthropocene, as the present era of globally pervasive anthropogenic influence on planet Earth and, thus, on the human environment, is characterized by a strong increase of carbon dioxide, ozone, nitrogen oxides, and combustion- or traffic-related particulate matter in the atmosphere. These environmental factors can enhance the abundance and induce chemical modifications of allergens, increase oxidative stress in the human body, and skew the immune system toward allergic reactions. In particular, air pollutants can act as adjuvants and alter the immunogenicity of allergenic proteins, while climate change affects the atmospheric abundance and human exposure to bioaerosols and aeroallergens. To fully understand and effectively mitigate the adverse effects of air pollution and climate change on allergic diseases, several challenges remain to be resolved. Among these are the identification and quantification of immunochemical reaction pathways involving allergens and adjuvants under relevant environmental and physiological conditions.
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Affiliation(s)
| | - Christopher J. Kampf
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
- Institute
of Inorganic and Analytical Chemistry, Johannes
Gutenberg University, Mainz, 55128, Germany
| | - Kurt Lucas
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Naama Lang-Yona
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | | | - Manabu Shiraiwa
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
- Department
of Chemistry, University of California, Irvine, California 92697-2025, United States
| | - Pascale S. J. Lakey
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Senchao Lai
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
- South
China University of Technology, School of
Environment and Energy, Guangzhou, 510006, China
| | - Fobang Liu
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Anna T. Kunert
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Kira Ziegler
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Fangxia Shen
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Rossella Sgarbanti
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Bettina Weber
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
| | - Iris Bellinghausen
- Department
of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, 55131, Germany
| | - Joachim Saloga
- Department
of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, 55131, Germany
| | - Michael G. Weller
- Division
1.5 Protein Analysis, Federal Institute
for Materials Research and Testing (BAM), Berlin, 12489, Germany
| | - Albert Duschl
- Department
of Molecular Biology, University of Salzburg, 5020 Salzburg, Austria
| | - Detlef Schuppan
- Institute
of Translational Immunology and Research Center for Immunotherapy,
Institute of Translational Immunology, University Medical Center, Johannes Gutenberg University, Mainz, 55131 Germany
- Division
of Gastroenterology, Beth Israel Deaconess
Medical Center and Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Ulrich Pöschl
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz, 55128, Germany
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Heffler E, Crimi C, Brussino L, Nicola S, Sichili S, Dughera L, Rolla G, Crimi N. Exhaled breath condensate pH and cysteinyl leukotriens in patients with chronic cough secondary to acid gastroesophageal reflux. J Breath Res 2016; 11:016002. [DOI: 10.1088/1752-7163/11/1/016002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Cavalcante de Sá M, Nakagawa NK, Saldiva de André CD, Carvalho-Oliveira R, de Santana Carvalho T, Nicola ML, de André PA, Nascimento Saldiva PH, Vaisberg M. Aerobic exercise in polluted urban environments: effects on airway defense mechanisms in young healthy amateur runners. J Breath Res 2016; 10:046018. [DOI: 10.1088/1752-7163/10/4/046018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Tuesta M, Alvear M, Carbonell T, García C, Guzmán-Venegas R, Araneda OF. Effect of exercise duration on pro-oxidants and pH in exhaled breath condensate in humans. J Physiol Biochem 2016; 72:353-60. [DOI: 10.1007/s13105-016-0486-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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van Mastrigt E, de Jongste JC, Pijnenburg MW. The analysis of volatile organic compounds in exhaled breath and biomarkers in exhaled breath condensate in children - clinical tools or scientific toys? Clin Exp Allergy 2016; 45:1170-88. [PMID: 25394891 DOI: 10.1111/cea.12454] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Current monitoring strategies for respiratory diseases are mainly based on clinical features, lung function and imaging. As airway inflammation is the hallmark of many respiratory diseases in childhood, noninvasive methods to assess the presence and severity of airway inflammation might be helpful in both diagnosing and monitoring paediatric respiratory diseases. At present, the measurement of fractional exhaled nitric oxide is the only noninvasive method available to assess eosinophilic airway inflammation in clinical practice. We aimed to evaluate whether the analysis of volatile organic compounds (VOCs) in exhaled breath (EB) and biomarkers in exhaled breath condensate (EBC) is helpful in diagnosing and monitoring respiratory diseases in children. An extensive literature search was conducted in Medline, Embase and PubMed on the analysis and applications of VOCs in EB and EBC in children. We retrieved 1165 papers, of which nine contained original data on VOCs in EB and 84 on biomarkers in EBC. These were included in this review. We give an overview of the clinical applications in childhood and summarize the methodological issues. Several VOCs in EB and biomarkers in EBC have the potential to distinguish patients from healthy controls and to monitor treatment responses. Lack of standardization of collection methods and analysis techniques hampers the introduction in clinical practice. The measurement of metabolomic profiles may have important advantages over detecting single markers. There is a lack of longitudinal studies and external validation to reveal whether EB and EBC analysis have added value in the diagnostic process and follow-up of children with respiratory diseases. In conclusion, the use of VOCs in EB and biomarkers in EBC as markers of inflammatory airway diseases in children is still a research tool and not validated for clinical use.
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Affiliation(s)
- E van Mastrigt
- Department of Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J C de Jongste
- Department of Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M W Pijnenburg
- Department of Paediatric Respiratory Medicine, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
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Bikov A, Pako J, Montvai D, Kovacs D, Koller Z, Losonczy G, Horvath I. Exhaled breath condensate pH decreases following oral glucose tolerance test. J Breath Res 2015; 9:047112. [DOI: 10.1088/1752-7155/9/4/047112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Walsh BK, Davis MD, Hunt JF, Kheir JN, Smallwood CD, Arnold JH. The effects of lung recruitment maneuvers on exhaled breath condensate pH. J Breath Res 2015; 9:036009. [PMID: 26333431 DOI: 10.1088/1752-7155/9/3/036009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Exhaled breath condensate (EBC) pH serves as a surrogate marker of airway lining fluid (ALF) pH and can be used to evaluate airway acidification (AA). AA is known to be present in acute respiratory distress syndrome (ARDS) and can be evaluated via continuous EBC pH measurement during mechanical ventilation. Lung recruitment maneuvers (LRMs) are utilized in the treatment of ARDS, however, their impact on EBC pH has never been explored. Here we described the acute effects of two commonly used LRMs on EBC pH. In a prospective, non-randomized, serial exposure study, 10 intubated pediatric subjects with acute respiratory distress syndrome sequentially underwent: a period of baseline ventilation, sustained inflation (SI) maneuver of 40 cm H2O for 40 s, open lung ventilation, staircase recruitment strategy (SRS) (which involves a systematic ramping of plateau pressures in 5 cm H2O increments, starting at 30 cm H2O), and PEEP titration. Maximum lung recruitment during the SRS is defined as a PaO2 + PaCO2 of >400 mmHg. Following lung recruitment, PEEP titration was conducted from 20 cm H2O in 2 cm H2O decrements until a PaO2 + PaCO2 was <380 and then increased by 2 cm H2O. EBC pH, arterial blood gases, lung mechanics, hemodynamics, and function residual capacity were obtained following each phase of the LRM and observational period. Seven out of 10 patients were able to reach maximum lung recruitment. Baseline EBC pH (6.38 ± 0.37) did not correlate with disease severity defined by PaO2/FiO2 ratio or oxygenation index (OI). Average EBC pH differed between phases and decreased after LRM (p = 0.001). EBC pH is affected by LRMs. EBC acidification following LRMs may represent a washout effect of opening acidic lung units and ventilating them or acute AA resulting from LRM.
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Affiliation(s)
- Brian K Walsh
- Boston Children's Hospital, 300 Longwood Ave, Farley 019, Boston, MA 02115, USA
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Moschino L, Zanconato S, Bozzetto S, Baraldi E, Carraro S. Childhood asthma biomarkers: present knowledge and future steps. Paediatr Respir Rev 2015; 16:205-12. [PMID: 26100359 DOI: 10.1016/j.prrv.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
Asthma represents the most common chronic respiratory disease of childhood. Its current standard diagnosis relies on patient history of symptoms and confirmed expiratory airflow limitation. Nevertheless, the spectrum of asthma in clinical presentation is broad, and both symptoms and lung function may not always reflect the underlying airway inflammation, which can be determined by different pathogenetic mechanisms. For these reasons, the identification of objective biomarkers of asthma, which may guide diagnosis, phenotyping, management and treatment is of great clinical utility and might have a role in the development of personalized therapy. The availability of non-invasive methods to study and monitor disease inflammation is of relevance especially in childhood asthma. In this sense, a promising role might be played by the measurement of exhaled biomarkers, such as exhaled nitric oxide (FE(NO)) and molecules in exhaled breath condensate (EBC). Furthermore, recent studies have shown encouraging results with the application of the novel metabolomic approach to the study of exhaled biomarkers. In this paper the existing knowledge in the field of asthma biomarkers, with a special focus on exhaled biomarkers, will be highlighted.
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Affiliation(s)
- Laura Moschino
- Department of Women's and Children's Health, University of Padova, Padova Italy
| | - Stefania Zanconato
- Department of Women's and Children's Health, University of Padova, Padova Italy
| | - Sara Bozzetto
- Department of Women's and Children's Health, University of Padova, Padova Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padova, Padova Italy
| | - Silvia Carraro
- Department of Women's and Children's Health, University of Padova, Padova Italy.
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Pöschl U, Shiraiwa M. Multiphase chemistry at the atmosphere-biosphere interface influencing climate and public health in the anthropocene. Chem Rev 2015; 115:4440-75. [PMID: 25856774 DOI: 10.1021/cr500487s] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ulrich Pöschl
- Multiphase Chemistry Department, Max Planck Institute for Chemistry, 55128 Mainz, Germany
| | - Manabu Shiraiwa
- Multiphase Chemistry Department, Max Planck Institute for Chemistry, 55128 Mainz, Germany
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Cancado JE, Mendes ES, Arana J, Horvath G, Monzon ME, Salathe M, Wanner A. Effect of airway acidosis and alkalosis on airway vascular smooth muscle responsiveness to albuterol. BMC Pharmacol Toxicol 2015; 16:9. [PMID: 25889594 PMCID: PMC4384333 DOI: 10.1186/s40360-015-0008-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background In vitro and animal experiments have shown that the transport and signaling of β2-adrenergic agonists are pH-sensitive. Inhaled albuterol, a hydrophilic β2-adrenergic agonist, is widely used for the treatment of obstructive airway diseases. Acute exacerbations of obstructive airway diseases can be associated with changes in ventilation leading to either respiratory acidosis or alkalosis thereby affecting albuterol responsiveness in the airway. The purpose of this study was to determine if airway pH has an effect on albuterol-induced vasodilation in the airway. Methods Ten healthy volunteers performed the following respiratory maneuvers: quiet breathing, hypocapnic hyperventilation, hypercapnic hyperventilation, and eucapnic hyperventilation (to dissociate the effect of pH from the effect of ventilation). During these breathing maneuvers, exhaled breath condensate (EBC) pH and airway blood flow response to inhaled albuterol (ΔQ̇aw) were assessed. Results Mean ± SE EBC pH (units) and ΔQ̇aw (μl.min-1.mL-1) were 6.4 ± 0.1 and 16.8 ± 1.9 during quiet breathing, 6.3 ± 0.1 and 14.5 ± 2.4 during eucapnic hyperventilation, 6.6 ± 0.2 and -0.2 ± 1.8 during hypocapnic hyperventilation (p = 0.02 and <0.01 vs. quiet breathing), and 5.9 ± 0.1 and 2.0 ± 1.5 during hypercapnic hyperventilation (p = 0.02 and <0.02 vs quiet breathing). Conclusions Albuterol responsiveness in the airway as assessed by ΔQ̇aw is pH sensitive. The breathing maneuver associated with decreased and increased EBC pH both resulted in a decreased responsiveness independent of the level of ventilation. These findings suggest an attenuated response to hydrophilic β2-adrenergic agonists during airway disease exacerbations associated with changes in pH. Trial registration Registered at clinicaltrials.gov: NCT01216748.
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Affiliation(s)
- Jose E Cancado
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Eliana S Mendes
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Johana Arana
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Gabor Horvath
- Department of Pulmonology, Semmelweis University School of Medicine, Budapest, Hungary.
| | - Maria E Monzon
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Matthias Salathe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
| | - Adam Wanner
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami School of Medicine, Miami, FL, 33136, USA.
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Nicola ML, Carvalho HBD, Yoshida CT, Anjos FMD, Nakao M, Santos UDP, Cardozo KHM, Carvalho VM, Pinto E, Farsky SHP, Saldiva PHN, Rubin BK, Nakagawa NK. Young "healthy" smokers have functional and inflammatory changes in the nasal and the lower airways. Chest 2014; 145:998-1005. [PMID: 24307008 DOI: 10.1378/chest.13-1355] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Smoking is responsible for most COPD. Although people with COPD often have concomitant nasal disease, there are few studies that report physiologic or inflammatory changes in the upper airways in young asymptomatic smokers. We investigated physiologic and inflammatory changes in the nasal and lower airways of young smokers and if these changes were related to smoking history. METHODS Seventy-two subjects aged between 18 and 35 years (32 healthy nonsmokers and 40 young smokers) participated in this study. We measured nasal mucociliary clearance (MCC), nasal mucus surface contact angle, cell counts, myeloperoxidase and cytokine concentrations in nasal lavage fluid, exhaled breath condensate (EBC) pH, and lung function. RESULTS Smokers had faster MCC, an increased number of cells (macrophages, ciliated cells, and goblet cells), increased lavage myeloperoxidase concentration, and decreased EBC pH compared with nonsmokers. There was a significant inverse relationship between pack-year smoking history and EBC pH. There were no differences in lung function or mucus surface properties comparing smokers to nonsmokers. CONCLUSIONS Young adult smokers have functional and inflammatory changes in the nasal and lower airways and these correlate with smoking history. However, in these young smokers, smoking history was not associated with pulmonary function decline, probably because it is unlikely that spirometry detects early physiologic changes in the airways. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01877291; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Marina Lazzari Nicola
- Department of Pathology, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Carolina Tieko Yoshida
- Department of Pathology, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabyana Maria Dos Anjos
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Universidade de São Paulo, São Paulo, Brazil
| | - Mayumi Nakao
- Department of Pathology, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ubiratan de Paula Santos
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ernani Pinto
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sandra Helena Poliselli Farsky
- Pulmonary Division, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Hilario Nascimento Saldiva
- Department of Pathology, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruce K Rubin
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Naomi Kondo Nakagawa
- Department of Pathology, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Fitzpatrick AM, Holbrook JT, Wei CY, Brown MS, Wise RA, Teague WG. Exhaled breath condensate pH does not discriminate asymptomatic gastroesophageal reflux or the response to lansoprazole treatment in children with poorly controlled asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:579-86.e7. [PMID: 25213052 DOI: 10.1016/j.jaip.2014.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/07/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although exhaled breath condensate (EBC) pH has been identified as an "emerging" biomarker of interest for asthma clinical trials, the clinical determinants of EBC pH remain poorly understood. Other studies have associated acid reflux-induced respiratory symptoms, for example, cough, with transient acidification of EBC. OBJECTIVE We sought to determine the clinical and physiologic correlates of EBC acidification in a highly characterized sample of children with poorly controlled asthma. We hypothesized that (1) children with asymptomatic gastroesophageal reflux determined by 24-hour esophageal pH monitoring would have a lower EBC pH than children without gastroesophageal reflux, (2) treatment with lansoprazole would alter EBC pH in those children, and (3) EBC acidification would be associated with increased asthma symptoms, poorer asthma control and quality of life, and increased formation of breath nitrogen oxides (NOx). METHODS A total of 110 children, age range 6 to 17 years, with poor asthma control and esophageal pH data enrolled in the Study of Acid Reflux in Children with Asthma (NCT00442013) were included. Children submitted EBC samples for pH and NOx measurement at randomization and at study weeks 8, 16, and 24. RESULTS Serial EBC pH measurements failed to distinguish asymptomatic gastroesophageal reflux and was not associated with breath NOx formation. EBC pH also did not discriminate asthma characteristics such as medication and health care utilization, pulmonary function, and asthma control and quality of life both at baseline and across the study period. CONCLUSION Despite the relative ease of EBC collection, EBC pH as a biomarker does not provide useful information of children with asthma who were enrolled in asthma clinical trials.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Center for Developmental Lung Biology, Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Janet T Holbrook
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md
| | - Christine Y Wei
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md
| | - Meredith S Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Robert A Wise
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md
| | - W Gerald Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Va
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Kubáň P, Foret F. Exhaled breath condensate: Determination of non-volatile compounds and their potential for clinical diagnosis and monitoring. A review. Anal Chim Acta 2013; 805:1-18. [DOI: 10.1016/j.aca.2013.07.049] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/16/2013] [Accepted: 07/20/2013] [Indexed: 12/31/2022]
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Increase of pro-oxidants with no evidence of lipid peroxidation in exhaled breath condensate after a 10-km race in non-athletes. J Physiol Biochem 2013; 70:107-15. [DOI: 10.1007/s13105-013-0285-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
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Leung TF, Ko FWS, Wong GWK. Recent advances in asthma biomarker research. Ther Adv Respir Dis 2013; 7:297-308. [PMID: 23907809 DOI: 10.1177/1753465813496863] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Asthma is characterized by recurrent and reversible airflow obstruction, which is routinely monitored by history and physical examination, spirometry and home peak flow diaries. As airway inflammation is central to asthma pathogenesis, its monitoring should be part of patient management plans. Fractional exhaled nitric oxide level (FeNO) is the most extensively studied biomarker of airway inflammation, and FeNO references were higher in Chinese (Asians) than Whites. Published evidence was inconclusive as to whether FeNO is a useful management strategy for asthma. Other biomarkers include direct (histamine, methacholine) and indirect (adenosine, hypertonic saline) challenges of bronchial hyperresponsiveness (BHR), induced sputum and exhaled breath condensate (EBC). A management strategy that normalized sputum eosinophils among adult patients resulted in reductions of BHR and asthma exacerbations. However, subsequent adult and pediatric studies failed to replicate these benefits. Asthma phenotypes as defined by inflammatory cell populations in sputum were also not stable over a 12-month period. A recent meta-analysis concluded that induced sputum is not accurate enough to be applied in routine monitoring of childhood asthma. There is poor correlation between biomarkers that reflect different asthma dimensions: spirometry (airway caliber), BHR (airway reactivity) and FeNO or induced sputum (airway inflammation). Lastly, EBC is easily obtained noninvasively by cooling expired air. Many biomarkers ranging from acidity (pH), leukotrienes, aldehydes, cytokines to growth factors have been described. However, significant overlap between groups and technical difficulty in measuring low levels of inflammatory molecules are the major obstacles for EBC research. Metabolomics is an emerging analytical method for EBC biomarkers. In conclusion, both FeNO and induced sputum are useful asthma biomarkers. However, they will only form part of the clinical picture. Longitudinal studies with focused hypotheses and well-designed protocols are needed to establish the roles of these biomarkers in asthma management. The measurement of biomarkers in EBC remains a research tool.
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Affiliation(s)
- Ting F Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Papaporfyriou A, Tseliou E, Loukides S, Kostikas K, Bakakos P. Noninvasive evaluation of airway inflammation in patients with severe asthma. Ann Allergy Asthma Immunol 2013; 110:316-21. [PMID: 23622000 DOI: 10.1016/j.anai.2012.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/26/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Anastasia Papaporfyriou
- Second Respiratory Medicine Department, University of Athens Medical School, Attiko Hospital, Athens, Greece
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Abstract
BACKGROUND Since little is known of airways inflammation in the elderly, we have carried out a study to explore the presence of some inflammatory markers in the airways of healthy subjects of different ages using a non-invasive method which is particularly suitable for aged people. OBJECTIVE The aim of this work was to investigate whether parameters, including (1) pH, IL-8 and TNF-α in exhaled breath condensate (EBC), (2) exhaled nitric oxide levels (NO), and (3) inflammatory cell profile in induced sputum, are age-related. MATERIALS AND METHODS Thirty healthy adults (10 subjects below the age of 30 [A], 10 subjects between 30 and 60 years [B], and 10 subjects over 60 years of age [C]), were enrolled in the study. IL-8 and TNF-α levels were measured in breath condensate. Exhaled pH was measured after deaeration/decarbonation by means of a pH-meter. A rapid-response chemiluminescence NO analyzer was used to quantify NO. Induced sputum was collected, homogenized with dithiothreitol, and cytospins for differential cell were produced. RESULTS The levels of IL-8 and TNF-α in EBC, the levels of exhaled NO, and the percentage of neutrophils in induced sputum were significantly elevated in C and B compared with A; the EBC pH level was significantly reduced in C and B compared with A. The EBC levels of IL-8, TNF-α, pH, the level of exhaled NO, and the percentage of neutrophils correlated significantly with age. CONCLUSION This study has shown the presence of age-related airways inflammation in healthy subjects.
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Glas N, Vergnon JM, Pacheco Y. [Interest for evaluation of bronchial inflammation in asthma]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:76-82. [PMID: 23434035 DOI: 10.1016/j.pneumo.2012.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/18/2012] [Accepted: 10/30/2012] [Indexed: 06/01/2023]
Abstract
Asthma is a heterogeneous chronic inflammatory disease. The respiratory functional tests are sometimes insufficient to confirm the diagnosis. Other tools are developed to estimate the bronchial inflammation such as tests of bronchial provocation, measure of exhaled nitric oxide, induced sputum and exhaled breath condensate. This review presents these non-invasive methods, approaches their interests on the identification of the disease and the treatment.
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Affiliation(s)
- N Glas
- Service de Pneumologie et D'oncologie Thoracique, Hôpital Nord, CHU de Saint-Étienne, France.
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Davis MD, Walsh BK, Dwyer ST, Combs C, Vehse N, Paget-Brown A, Pajewski T, Hunt JF. Safety of an alkalinizing buffer designed for inhaled medications in humans. Respir Care 2012; 58:1226-32. [PMID: 23258576 DOI: 10.4187/respcare.01753] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Airway acidification plays a role in disorders of the pulmonary tract. We hypothesized that the inhalation of alkalinized glycine buffer would measurably alkalinize the airways without compromising lung function or causing adverse events. We evaluated the safety of an inhaled alkaline glycine buffer in both healthy subjects and in subjects with stable obstructive airway disease. METHODS This work includes 2 open-label safety studies. The healthy controls were part of a phase 1 safety study of multiple inhalations of low-dose alkaline glycine buffer; nebulized saline was used as a comparator in 8 of the healthy controls. Subsequently, a phase 2 study in subjects with stable obstructive airway disease was completed using a single nebulized higher-dose strategy of the alkaline inhalation. We studied 20 non-smoking adults (10 healthy controls and 10 subjects with obstructive airway disease), both at baseline and after inhalation of alkaline buffer. We used spirometry and vital signs as markers of clinical safety. We used changes in fraction of exhaled nitric oxide (NO) and exhaled breath condensate (EBC) pH as surrogate markers of airway pH modification. RESULTS Alkaline glycine inhalation was tolerated by all subjects in both studies, with no adverse effects on spirometric parameters or vital signs. Airway alkalinization was confirmed by a median increase in EBC pH of 0.235 pH units (IQR 0.56-0.03, P = .03) in subjects after inhalation of the higher-dose alkaline buffer (2.5 mL of 100 mmol/L glycine). CONCLUSIONS Alkalinization of airway lining fluid is accomplished with inhalation of alkaline glycine buffer and causes no adverse effects on pulmonary function or vital signs.
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Affiliation(s)
- Michael D Davis
- Adult Health and Nursing System, Virginia Commonwealth University, Richmond, VA 23298, USA.
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38
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Kostikas K, Minas M, Nikolaou E, Papaioannou AI, Liakos P, Gougoura S, Gourgoulianis KI, Dinas PC, Metsios GS, Jamurtas AZ, Flouris AD, Koutedakis Y. Secondhand smoke exposure induces acutely airway acidification and oxidative stress. Respir Med 2012; 107:172-9. [PMID: 23218453 DOI: 10.1016/j.rmed.2012.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/27/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
Previous studies have shown that secondhand smoke induces lung function impairment and increases proinflammatory cytokines. The aim of the present study was to evaluate the acute effects of secondhand smoke on airway acidification and airway oxidative stress in never-smokers. In a randomized controlled cross-over trial, 18 young healthy never-smokers were assessed at baseline and 0, 30, 60, 120, 180 and 240 min after one-hour secondhand smoke exposure at bar/restaurant levels. Exhaled NO and CO measurements, exhaled breath condensate collection (for pH, H(2)O(2) and NO(2)(-)/NO(3)(-) measurements) and spirometry were performed at all time-points. Secondhand smoke exposure induced increases in serum cotinine and exhaled CO that persisted until 240 min. Exhaled breath condensate pH decreased immediately after exposure (p < 0.001) and returned to baseline by 180 min, whereas H(2)O(2) increased at 120 min and remained increased at 240 min (p = 0.001). No changes in exhaled NO and NO(2)/NO(3) were observed, while decreases in FEV(1) (p < 0.001) and FEV(1)/FVC (p < 0.001) were observed after exposure and returned to baseline by 180 min. A 1-h exposure to secondhand smoke induced airway acidification and increased airway oxidative stress, accompanied by significant impairment of lung function. Despite the reversal in EBC pH and lung function, airway oxidative stress remained increased 4 h after the exposure. Clinical trial registration number (EudraCT): 2009-013545-28.
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Affiliation(s)
- Konstantinos Kostikas
- Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece.
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Ljubičić Ćalušić A, Marin M, Veda Marija V, Branko P, Jelena M, Nevenka K, Vrdoljak Ana L, Davor Ž. Biomarkers of mild hyperthermia related to flashover training in firefighters. J Therm Biol 2012. [DOI: 10.1016/j.jtherbio.2012.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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de Broucker V, Hassoun SM, Hulo S, Chérot-Kornobis N, Nevière R, Matran R, Sobaszek A, Edme JL. Non-invasive collection of exhaled breath condensate in rats: Evaluation of pH, H2O2 and NOx in lipopolysaccharide-induced acute lung injury. Vet J 2012; 194:222-8. [DOI: 10.1016/j.tvjl.2012.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 11/30/2022]
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Ljubičić Ćalušić A, Varnai VM, Cavlović AO, Segvić Klarić M, Beljo R, Prester L, Macan J. Respiratory health and breath condensate acidity in sawmill workers. Int Arch Occup Environ Health 2012; 86:815-25. [PMID: 23007314 DOI: 10.1007/s00420-012-0817-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the study was to evaluate exhaled breath condensate acidity (EBC pH) as a biomarker of airway response to occupational respiratory hazards present in sawmill. METHODS Sixty-one sawmill workers in total (26 from Sawmill 1 and 35 from Sawmill 2) provided EBC samples at the beginning and at the end of the working week. Respiratory symptoms, lung function, bronchodilator test and atopy status were assessed. Occupational environment was checked for the levels of respiratory hazards. RESULTS Airborne dust concentrations were below threshold limit value. Endotoxin in Sawmill 1 and Sawmill 2, and moulds in Sawmill 1 were at the levels able to induce inflammatory response in the airways. Mould levels were 2.5 times higher in Sawmill 1 than in Sawmill 2. Compared to Sawmill 2 workers, lower spirometry values, higher prevalence of dry cough and positive bronchodilator test were found in Sawmill 1 workers. Monday EBC pH values did not differ between sawmills, but declined after one working week in Sawmill 1 workers (from 7.88 to 7.49, P = 0.012) and not in Sawmill 2 workers. Similar results were obtained when only respiratory healthy non-smokers were analysed. Monday-to-Friday change of other respiratory parameters was not observed. CONCLUSION The results suggest EBC pH as a biomarker of acute respiratory effects related to occupational exposure to respiratory hazards in sawmills, presumably increased mould levels. The effect was present even at subclinical level, namely in respiratory healthy subjects. The long-term health implications remain unclear and should be evaluated in a follow-up study.
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Affiliation(s)
- Anita Ljubičić Ćalušić
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10001, Zagreb, Croatia,
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Abstract
Exhaled breath condensate (EBC) is a promising source of biomarkers of lung disease. EBC may be thought of either as a body fluid or as a condensate of exhaled gas. There are 3 principal contributors to EBC: variable-sized particles or droplets that are aerosolized from the airway lining fluid, distilled water that condenses from gas phase out of the nearly water-saturated exhalate, and water-soluble volatiles that are exhaled and absorbed into the condensing breath. The nonvolatile constituents and the water-soluble volatile constituents are of particular interest. Several key issues are discussed in this article.
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Breath biomarkers in diagnosis of pulmonary diseases. Clin Chim Acta 2012; 413:1770-80. [PMID: 22796631 DOI: 10.1016/j.cca.2012.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 05/20/2012] [Accepted: 07/05/2012] [Indexed: 12/29/2022]
Abstract
Breath analysis provides a convenient and simple alternative to traditional specimen testing in clinical laboratory diagnosis. As such, substantial research has been devoted to the analysis and identification of breath biomarkers. Development of new analytes enhances the desirability of breath analysis especially for patients who monitor daily biochemical parameters. Elucidating the physiologic significance of volatile substances in breath is essential for clinical use. This review describes the use of breath biomarkers in diagnosis of asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), lung cancer, as well as other pulmonary diseases. A number of breath biomarkers in lung pathophysiology will be described including nitric oxide (NO), carbon monoxide (CO), hydrogen peroxide (H₂O₂) and other hydrocarbons.
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Residential proximity to a major roadway is associated with features of asthma control in children. PLoS One 2012; 7:e37044. [PMID: 22615884 PMCID: PMC3355164 DOI: 10.1371/journal.pone.0037044] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/12/2012] [Indexed: 11/19/2022] Open
Abstract
Background While several studies suggest that traffic-related air pollutants are detrimental for respiratory health, few studies have examined relationships between residential proximity to a major roadway and asthma control in children. Furthermore, a major limitation of existing research is reliance on self-reported outcomes. We therefore determined the spatial relationship between the distance from a major roadway and clinical, physiologic and inflammatory features of asthma in a highly characterized sample of asthmatic children 6–17 years of age across a wide range of severities. We hypothesized that a closer residential proximity to a major roadway would be associated with increased respiratory symptoms, altered pulmonary function and a greater magnitude of airway and systemic inflammation. Methodology/Principal Findings 224 children 6–17 years with confirmed asthma completed questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, exhaled breath condensate collection and venipuncture. Residential distance from a major roadway was determined by mapping the geographic coordinates of the residential address in Geographic Information System software. The distance between the home address and the nearest major roadway was calculated according to the shortest distance between the two points (i.e., “as the crow flies”). Asthmatic children living in closer proximity to a major roadway had an increased frequency of wheezing associated with increased medication requirements and more hospitalizations even after controlling for potential confounders. These children also had increased airway resistance, increased airway inflammation reflected by a lower breath condensate pH, and higher plasma EGF concentrations. Conclusions/Significance These findings suggest that closer residential proximity to a major roadway is associated with poorer asthma control in school-age children. Assessment of residential proximity to major roadways may be useful in the clinical evaluation of asthma in children.
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Szefler SJ, Wenzel S, Brown R, Erzurum SC, Fahy JV, Hamilton RG, Hunt JF, Kita H, Liu AH, Panettieri RA, Schleimer RP, Minnicozzi M. Asthma outcomes: biomarkers. J Allergy Clin Immunol 2012; 129:S9-23. [PMID: 22386512 DOI: 10.1016/j.jaci.2011.12.979] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/23/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Measurement of biomarkers has been incorporated within clinical research studies of asthma to characterize the population and associate the disease with environmental and therapeutic effects. OBJECTIVE National Institutes of Health institutes and federal agencies convened an expert group to propose which biomarkers should be assessed as standardized asthma outcomes in future clinical research studies. METHODS We conducted a comprehensive search of the literature to identify studies that developed and/or tested asthma biomarkers. We identified biomarkers relevant to the underlying disease process progression and response to treatment. We classified the biomarkers as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011. RESULTS Ten measures were identified; only 1, multiallergen screening to define atopy, is recommended as a core asthma outcome. Complete blood counts to measure total eosinophils, fractional exhaled nitric oxide (Feno), sputum eosinophils, urinary leukotrienes, and total and allergen-specific IgE are recommended as supplemental measures. Measurement of sputum polymorphonuclear leukocytes and other analytes, cortisol measures, airway imaging, breath markers, and system-wide studies (eg, genomics, proteomics) are considered as emerging outcome measures. CONCLUSION The working group participants propose the use of multiallergen screening in all asthma clinical trials to characterize study populations with respect to atopic status. Blood, sputum, and urine specimens should be stored in biobanks, and standard procedures should be developed to harmonize sample collection for clinical trial biorepositories.
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Shiraiwa M, Selzle K, Pöschl U. Hazardous components and health effects of atmospheric aerosol particles: reactive oxygen species, soot, polycyclic aromatic compounds and allergenic proteins. Free Radic Res 2012; 46:927-39. [DOI: 10.3109/10715762.2012.663084] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The collection and analysis of exhaled breath condensate (EBC) may be useful for the management of patients with chronic respiratory disease at all ages. It is a promising technique due to its apparent simplicity and non-invasiveness. EBC does not disturb an ongoing respiratory inflammation. However, the methodology remains controversial, as it is not yet standardized. The current diversity of the methods used to collect and preserve EBC, the analytical pitfalls and the high degree of within-subject variability are the main issues that hamper further development into a clinical useful technique. In order to facilitate the process of standardization, a simplified schematic approach is proposed. An update of available data identified open issues on EBC methodology. These issues were then classified into three separate conditions related to their influence before, during or after the condensation process: (1) pre-condenser conditions related to subject and/or environment; (2) condenser conditions related to condenser equipment; and (3) post-condenser conditions related to preservation and/or analysis. This simplified methodological approach highlights the potential influence of the many techniques used before, during and after condensation of exhaled breath. It may also serve as a methodological checklist for a more systematical approach of EBC research and development.
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Affiliation(s)
- Philippe Rosias
- Department of Paediatrics, Orbis Medical Center, Sittard, The Netherlands.
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Assessment of the impact of collection temperature and sampler design on the measurement of exhaled breath condensate pH in healthy horses. Vet J 2012; 191:208-12. [DOI: 10.1016/j.tvjl.2010.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/25/2010] [Accepted: 12/11/2010] [Indexed: 11/21/2022]
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Cathcart MP, Love S, Hughes KJ. The application of exhaled breath gas and exhaled breath condensate analysis in the investigation of the lower respiratory tract in veterinary medicine: A review. Vet J 2011; 191:282-91. [PMID: 21908213 DOI: 10.1016/j.tvjl.2011.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/12/2011] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
Abstract
The analysis of biomarkers in exhaled breath (EB) and exhaled breath condensate (EBC) may allow non-invasive and repeatable assessment of respiratory health and disease in mammals. Compared to human medicine, however, research data from EB and EBC analysis in veterinary medicine are limited and more patient variables influencing concentrations of EB/EBC analytes may be present. In addition, variations in methodologies between studies may influence results. A comparison of the approaches used in veterinary research by different groups may aid in the identification of potentially reliable and repeatable biomarkers suitable for further investigation. To date, changes in acid-base status and increased concentrations of inflammatory mediators have been the main findings in studies of pulmonary disease states in animals. Whilst these biomarkers are unlikely to represent specific and sensitive diagnostic parameters, they do have potential application in monitoring disease progression and treatment response.
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Affiliation(s)
- M P Cathcart
- Weipers Centre for Equine Welfare, School of Veterinary Medicine, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, Bearsden Road, Glasgow G611QH, UK
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