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      A modeling-based evaluation of isothermal rebreathing for breath gas analyses of highly soluble volatile organic compounds

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          Abstract

          Isothermal rebreathing has been proposed as an experimental technique for estimating the alveolar levels of hydrophilic volatile organic compounds (VOCs) in exhaled breath. Using the prototypic test compound acetone we demonstrate that the end-tidal breath profiles of such substances during isothermal rebreathing show characteristics that contradict the conventional pulmonary inert gas elimination theory due to Farhi. On the other hand, these profiles can reliably be captured by virtue of a previously developed mathematical model for the general exhalation kinetics of highly soluble, blood-borne VOCs, which explicitly takes into account airway gas exchange as major determinant of the observable breath output. This model allows for a mechanistic analysis of various rebreathing protocols suggested in the literature. In particular, it clarifies the discrepancies between in vitro and in vivo blood-breath ratios of hydrophilic VOCs and yields further quantitative insights into the physiological components of isothermal rebreathing.

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          Diagnostic potential of breath analysis--focus on volatile organic compounds.

          Wolfram Miekisch, Jochen K. Schubert, Gabriele Noeldge-Schomburg (2004)
          Breath analysis has attracted a considerable amount of scientific and clinical interest during the last decade. In contrast to NO, which is predominantly generated in the bronchial system, volatile organic compounds (VOCs) are mainly blood borne and therefore enable monitoring of different processes in the body. Exhaled ethane and pentane concentrations were elevated in inflammatory diseases. Acetone was linked to dextrose metabolism and lipolysis. Exhaled isoprene concentrations showed correlations with cholesterol biosynthesis. Exhaled levels of sulphur-containing compounds were elevated in liver failure and allograft rejection. Looking at a set of volatile markers may enable recognition and diagnosis of complex diseases such as lung or breast cancer. Due to technical problems of sampling and analysis and a lack of normalization and standardization, huge variations exist between results of different studies. This is among the main reasons why breath analysis could not yet been introduced into clinical practice. This review addresses the basic principles of breath analysis and the diagnostic potential of different volatile breath markers. Analytical procedures, issues concerning biochemistry and exhalation mechanisms of volatile substances, and future developments will be discussed.
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            Dynamic profiles of volatile organic compounds in exhaled breath as determined by a coupled PTR-MS/GC-MS study.

            Andrew King, P Mochalski, A Amann … (2010)
            In this phenomenological study we focus on dynamic measurements of volatile organic compounds (VOCs) in exhaled breath under exercise conditions. An experimental setup efficiently combining breath-by-breath analyses using proton transfer reaction mass spectrometry (PTR-MS) with data reflecting the behaviour of major hemodynamic and respiratory parameters is presented. Furthermore, a methodology for complementing continuous VOC profiles obtained by PTR-MS with simultaneous SPME/GC-MS measurements is outlined. These investigations aim at evaluating the impact of breathing patterns, cardiac output or blood pressure on the observed breath concentration and allow for the detection and identification of several VOCs revealing characteristic rest-to-work transitions in response to variations in ventilation or perfusion. Examples of such compounds include isoprene, methyl acetate, butane, DMS and 2-pentanone. In particular, both isoprene and methyl acetate exhibit a drastic rise in concentration shortly after the onset of exercise, usually by a factor of about 3-5 within approximately 1 min of pedalling. These specific VOCs might also be interpreted as potentially sensitive indicators for fluctuations of blood or respiratory flow and can therefore be viewed as candidate compounds for future assessments of hemodynamics, pulmonary function and gas exchange patterns via observed VOC behaviour.
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              Breath acetone-aspects of normal physiology related to age and gender as determined in a PTR-MS study.

              A. Pizzini, W Miekisch, Jochen K. Schubert … (2009)
              The present study was performed to determine the variations of breath acetone concentrations with age, gender and body-mass index (BMI). Previous investigations were based on a relatively small cohort of subjects (see Turner et al 2006 Physiol. Meas. 27 321-37). Since exhaled breath analysis is affected by considerable variation, larger studies are needed to get reliable information about the correlation of concentrations of volatiles in breath when compared with age, gender and BMI. Mixed expiratory exhaled breath was sampled using Tedlar bags. The concentrations of a mass-to-charge ratio (m/z) of 59, attributed to acetone, were then determined using proton transfer reaction-mass spectrometry. Our cohort, consisting of 243 adult volunteers not suffering from diabetes, was divided into two groups: one that fasted overnight prior to sampling (215 volunteers) and the other without a dietary control (28 volunteers). In addition, we considered a group of 44 healthy children (5-11 years old).The fasted subjects' concentrations of acetone ranged from 177 ppb to 2441 ppb, with an overall geometric mean (GM) of 628 ppb; in the group without a dietary control, the subjects' concentrations ranged from 281 ppb to 1246 ppb with an overall GM of 544 ppb. We found no statistically significant shift between the distributions of acetone levels in the breath of males and females in the fasted group (the Wilcoxon-Mann-Whitney test yielded p = 0.0923, the medians being 652 ppb and 587 ppb). Similarly, there did not seem to be a difference between the acetone levels of males and females in the group without a dietary control. Aging was associated with a slight increase of acetone in the fasted females; in males the increase was not statistically significant. Compared with the adults (a merged group), our group of children (5-11 years old) showed lower concentrations of acetone (p < 0.001), with a median of 263 ppb. No correlation was found between the acetone levels and BMI in adults. Our results extend those of Turner et al's (2006 Physiol. Meas. 27 321-37), who analyzed the breath of 30 volunteers (without a dietary control) by selected ion flow tube-mass spectrometry. They reported a positive correlation with age (but without statistical significance in their cohort, with p = 0.82 for males and p = 0.45 for females), and, unlike us, arrived at a p-value of 0.02 for the separation of males and females with respect to acetone concentrations. Our median acetone concentration for children (5-11 years) coincides with the median acetone concentration of young adults (17-19 years) reported by Spanel et al (2007 J. Breath Res. 1 026001).
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                Author and article information

                Journal
                Publication date Created: 04 May 2011
                Publication date Updated: 2011-12-16
                Article
                DOI: 10.1088/1752-7155/6/1/016005
                ArXiV ID: 1105.0864
                SO-VID: 39a2166b-5e70-40ca-93f7-220b29e213d1
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                http://arxiv.org/licenses/nonexclusive-distrib/1.0/

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                Custom metadata
                Journal reference J. Breath Res. 6, 016005, 11pp (2012)
                Comments 21 pages
                Categories q-bio.QM physics.med-ph

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