The promise and perils of exhaled breath condensates

The exhaled breath condensate (EBC) approach provides a convenient and noninvasive approach for sampling the pulmonary epithelial lining fluid (ELF). Increased EBC concentrations of more than a dozen inflammatory markers and hydrogen ions have been reported in lung diseases associated with inflammation. However, the usefulness of EBC is compromised by uncertainties concerning the sources of the EBC droplets and by the extreme and variable dilution of ELF droplets with condensed water vapor (∼20,000-fold). Reported increases in EBC concentrations may reflect proportionate increases in the total volume rather than the concentration of ELF droplets in the collected samples. Conclusions regarding ELF concentrations can only be made if this dilution is estimated with a dilutional indicator (e.g., conductivity of lyophilized EBC). In normal EBC samples, pH is effectively set by oral contamination with NH3, and EBC pH cannot provide reliable information regarding ELF pH in normal subjects. Acidification of EBC observed in asthma and other conditions may reflect acidification of ELF, decreases in NH3 added to the EBC, and/or the presence of gastric droplets in the EBC.

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Exhaled Breath Condensate: Pilot Study of the Method and Initial Experience in Healthy Subjects

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2018.17 ◽

2018 ◽

Vol 61 (1) ◽

pp. 8-16

Author(s):

Eva Peterová ◽

Jaroslav Chládek ◽

Darina Kohoutová ◽

Veronika Knoblochová ◽

Paula Morávková ◽

...

Keyword(s):

Pilot Study ◽

Healthy Volunteers ◽

Coefficient Of Variation ◽

Healthy Subjects ◽

Lung Diseases ◽

Exhaled Breath Condensate ◽

Exhaled Breath ◽

Initial Experience ◽

Major Disadvantage ◽

Breath Condensate

Analysis of Exhaled breath condensate (EBC) is a re-discovered approach to monitoring the course of the disease and reduce invasive methods of patient investigation. However, the major disadvantage and shortcoming of the EBC is lack of reliable and reproducible standardization of the method. Despite many articles published on EBC, until now there is no clear consensus on whether the analysis of EBC can provide a clue to diagnosis of the diseases. The purpose of this paper is to investigate our own method, to search for possible standardization and to obtain our own initial experience. Thirty healthy volunteers provided the EBC, in which we monitored the density, pH, protein, chloride and urea concentration. Our results show that EBC pH is influenced by smoking, and urea concentrations are affected by the gender of subjects. Age of subjects does not play a role. The smallest coefficient of variation between individual volunteers is for density determination. Current limitations of EBC measurements are the low concentration of many biomarkers. Standardization needs to be specific for each individual biomarker, with focusing on optimal condensate collection. EBC analysis has a potential become diagnostic test, not only for lung diseases.

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Exhaled Breath Condensate: A Promising Source for Biomarkers of Lung Disease

The Scientific World JOURNAL ◽

10.1100/2012/217518 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Yan Liang ◽

Samantha M. Yeligar ◽

Lou Ann S. Brown

Keyword(s):

Lung Diseases ◽

Exhaled Breath Condensate ◽

Analytical Techniques ◽

Exhaled Breath ◽

Sample Collection ◽

Low Concentrations ◽

Reduced And Oxidized Glutathione ◽

Promising Source ◽

Breath Condensate ◽

Arachidonic Acid Derivatives

Exhaled breath condensate (EBC) has been increasingly studied as a noninvasive research method for sampling the alveolar and airway space and is recognized as a promising source of biomarkers of lung diseases. Substances measured in EBC include oxidative stress and inflammatory mediators, such as arachidonic acid derivatives, reactive oxygen/nitrogen species, reduced and oxidized glutathione, and inflammatory cytokines. Although EBC has great potential as a source of biomarkers in many lung diseases, the low concentrations of compounds within the EBC present challenges in sample collection and analysis. Although EBC is viewed as a noninvasive method for sampling airway lining fluid (ALF), validation is necessary to confirm that EBC truly represents the ALF. Likewise, a dilution factor for the EBC is needed in order to compare across subjects and determine changes in the ALF. The aims of this paper are to address the characteristics of EBC; strategies to standardize EBC sample collection and review available analytical techniques for EBC analysis.

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Use of exhaled breath condensate to investigate occupational lung diseases

Current Opinion in Allergy and Clinical Immunology ◽

10.1097/aci.0b013e3283357fb7 ◽

2010 ◽

Vol 10 (2) ◽

pp. 93-98 ◽

Cited By ~ 43

Author(s):

Massimo Corradi ◽

Petra Gergelova ◽

Antonio Mutti

Keyword(s):

Lung Diseases ◽

Exhaled Breath Condensate ◽

Exhaled Breath ◽

Occupational Lung Diseases ◽

Breath Condensate

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Validity Assessment for the Results of Three Inflammatory Markers in Exhaled Breath Condensate: A Pilot Study

Chromatographia ◽

10.1365/s10337-009-1313-7 ◽

2009 ◽

Vol 70 (9-10) ◽

pp. 1387-1392 ◽

Cited By ~ 2

Author(s):

Luis M. Gonzalez-Reche ◽

Dirk Schaefer ◽

Thomas Göen ◽

Thomas Kraus

Keyword(s):

Pilot Study ◽

Inflammatory Markers ◽

Exhaled Breath Condensate ◽

Exhaled Breath ◽

Validity Assessment ◽

Breath Condensate

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Exhaled Inflammatory Markers in Aspirin-Induced Asthma Syndrome

American Journal of Rhinology ◽

10.2500/ajr.2007.21.3066 ◽

2007 ◽

Vol 21 (5) ◽

pp. 542-547 ◽

Cited By ~ 8

Author(s):

Giovanna E. Carpagnano ◽

Onofrio Resta ◽

Matteo Gelardi ◽

Antonio Spanevello ◽

Giuseppe Di Gioia ◽

...

Keyword(s):

Inflammatory Markers ◽

Healthy Subjects ◽

Nasal Polyposis ◽

Exhaled Breath Condensate ◽

Mild Asthma ◽

Exhaled Breath ◽

Eosinophilic Inflammation ◽

Pathological Conditions ◽

Lower Airways ◽

Breath Condensate

Background Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced asthma (AIA) syndrome, evaluating possible differences between AIA and the single pathological conditions included in AIA syndrome. Methods Twelve patients with AIA, 17 patients with mild asthma (MA), 12 patients with nasal polyposis (NP), 11 patients with mild asthma + nasal polyposis (MA + NP), and 10 healthy subjects (HSs) were enrolled. Nasal and oral exhaled IL-4 and IL-6 were measured by enzyme immunoassay kit. Results Higher levels of nasal and oral exhaled IL-4 and IL-6 were observed in AIA compared with MA, NP, MA + NP, and HSs. Moreover, a positive correlation was identified between nasal exhaled IL-4 and IL-6 and, respectively, the number of neutrophils and eosinophils and in nasal scraping. Conclusion The concentration of eosinophilic and neutrophilic markers in upper and lower airways of subjects with AIA syndrome is higher compared with HS and subjects with MA, NP, and MA + NP.

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Metallic elements in exhaled breath condensate of patients with interstitial lung diseases

Journal of Breath Research ◽

10.1088/1752-7155/3/4/046003 ◽

2009 ◽

Vol 3 (4) ◽

pp. 046003 ◽

Cited By ~ 15

Author(s):

Massimo Corradi ◽

Olga Acampa ◽

Matteo Goldoni ◽

Elena Adami ◽

Pietro Apostoli ◽

...

Keyword(s):

Lung Diseases ◽

Exhaled Breath Condensate ◽

Interstitial Lung Diseases ◽

Exhaled Breath ◽

Metallic Elements ◽

Breath Condensate

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Investigation of pH of the exhaled breath condensate in inflammatory lung diseases

Russian Pulmonology ◽

10.18093/0869-0189-2005-0-5-75-79 ◽

2005 ◽

pp. 75-79

Author(s):

E. Kh. Anaev ◽

S. N. Avdeev ◽

A. G. Chuchalin

Keyword(s):

Cystic Fibrosis ◽

Healthy Volunteers ◽

Lung Diseases ◽

Ph Monitoring ◽

Exhaled Breath Condensate ◽

Stable Condition ◽

Exhaled Breath ◽

Lung Pathology ◽

Evaluation And Monitoring ◽

Breath Condensate

Investigation of inflammatory markers in the exhaled breath condensate (EBC) is a non-invasive method for evaluation and monitoring of bronchopulmonary inflammation. Endogenous oxidative processes in the airways can be evaluated by pH measurement in the EBC. We examined 153 healthy volunteers (of them, 51 smokers) and 615 patients with lung pathology (of them, 131 asthma (BA) patients, 205 COPD patients, 43 patients with bronchiectasis, 72 patients with idiopathic lung fibrosis (ILF), 142 pneumonia patients, and 42 cystic fibrosis patients). EBC was collected with ECoScreen equipment (Erich Jaeger, Germany) using a standardized method. The EBC pH was measured using the f32 PH-meter (Beckman, USA) with a glass microelectrode. The average ECB pH was 6.16 ± 0.52 in BA, 6.35 ± 0.56 in COPD, 6.13 ± 0.46 in bronchiectasis, 5.98 ± 0.30 in ILF, 5.96 ± 0.37 in pneumonia, and 6.35 ± 0.23 in cystic fibrosis. It was significantly lower than in the healthy volunteers (6.97 ± 0.31, р < 0.0001). In patients with exacerbation of BA and COPD ECB pH was considerably lower compared with those in stable condition. A reliable growth of pH was noted in pneumonia patients after treatment of the disease. There was a correlation between ECB pH and severity of fibrotic and inflammatory disorders of lung tissue according to HRCT (r = –0.62, p = 0.01), lung diffusing capacity (r = 0.51, p = 0.01), Tiffeneau index (r = 0.68, p = 0.004) in ILF. Therefore, the ECB pH is a distinct marker of the airway inflammatory severity in lung pathology. The ECB pH monitoring can assess the inflammatory activity and efficacy of anti-inflammatory therapy in lung diseases.

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