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      Use of the ReCIVA device in breath sampling of patients with acute breathlessness: a feasibility study

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          Abstract

          Introduction

          Investigating acute multifactorial undifferentiated breathlessness and understanding the driving inflammatory processes can be technically challenging in both adults and children. Being able to validate noninvasive methods such as breath analysis would be a huge clinical advance. The ReCIVA® device allows breath samples to be collected directly onto sorbent tubes at the bedside for analysis of exhaled volatile organic compounds (eVOCs). We aimed to assess the feasibility of using this device in acutely breathless patients.

          Methods

          Adults hospitalised with acute breathlessness and children aged 5–16 years with acute asthma or chronic stable asthma, as well as healthy adult and child volunteers, were recruited. Breath samples were collected onto sorbent tubes using the ReCIVA® device and sent for analysis by means of two-dimensional gas chromatography-mass spectrometry (GCxGC-MS). The NASA Task Load Index (NASA-TLX) was used to assess the perceived task workload of undertaking sampling from the patient's perspective.

          Results

          Data were available for 65 adults and 61 children recruited. In total, 98.4% of adults and 75.4% of children were able to provide the full target breath sample using the ReCIVA® device. NASA-TLX measurements were available in the adult population with mean values of 3.37 for effort, 2.34 for frustration, 3.8 for mental demand, 2.8 for performance, 3.9 for physical demand and 2.8 for temporal demand.

          Discussion

          This feasibility study demonstrates it is possible and acceptable to collect breath samples from both adults and children at the bedside for breathomics analysis using the ReCIVA® device.

          Abstract

          It is feasible to collect breath samples for breath analysis at the bedside using the ReCIVA device in acutely breathless adults and children https://bit.ly/2ZTonWo

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          Most cited references32

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          Nasa-Task Load Index (NASA-TLX); 20 Years Later

          S. G. Hart (2006)
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            An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.

            Dyspnea is a common, distressing symptom of cardiopulmonary and neuromuscular diseases. Since the ATS published a consensus statement on dyspnea in 1999, there has been enormous growth in knowledge about the neurophysiology of dyspnea and increasing interest in dyspnea as a patient-reported outcome. The purpose of this document is to update the 1999 ATS Consensus Statement on dyspnea. An interdisciplinary committee of experts representing ATS assemblies on Nursing, Clinical Problems, Sleep and Respiratory Neurobiology, Pulmonary Rehabilitation, and Behavioral Science determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant expertise. The final content of this statement was agreed upon by all members. Progress has been made in clarifying mechanisms underlying several qualitatively and mechanistically distinct breathing sensations. Brain imaging studies have consistently shown dyspnea stimuli to be correlated with activation of cortico-limbic areas involved with interoception and nociception. Endogenous and exogenous opioids may modulate perception of dyspnea. Instruments for measuring dyspnea are often poorly characterized; a framework is proposed for more consistent identification of measurement domains. Progress in treatment of dyspnea has not matched progress in elucidating underlying mechanisms. There is a critical need for interdisciplinary translational research to connect dyspnea mechanisms with clinical treatment and to validate dyspnea measures as patient-reported outcomes for clinical trials.
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              Chronic inflammation and asthma

              Allergic asthma is a complex and chronic inflammatory disorder which is associated with airway hyper-responsiveness and tissue remodelling of the airway structure. Although originally thought to be a Th2-driven inflammatory response to inhaled innocuous allergen, the immune response in asthma is now considered highly heterogeneous. There are now various in vivo systems which have been designed to examine the pathways leading to the development of this chronic immune response and reflect, in part this heterogeneity. Furthermore, the emergence of endogenous immunoregulatory pathways and active pro-resolving mediators hold great potential for future therapeutic intervention. In this review, the key cellular and molecular mediators relating to chronic allergic airway disease are discussed, as well as emerging players in the regulation of chronic allergic inflammation.
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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                October 2020
                23 November 2020
                : 6
                : 4
                : 00119-2020
                Affiliations
                [1 ]NIHR Leicester Biomedical Research Centre (Respiratory Theme), Glenfield Hospital, Leicester, UK
                [2 ]Loughborough University, Loughborough, UK
                [3 ]Dept of Chemistry, University of Leicester, Leicester, UK
                [4 ]NIHR Leicester Clinical Research Facility, Leicester Royal Infirmary, Leicester, UK
                [5 ]These authors contributed equally
                Author notes
                Erol A. Gaillard, University of Leicester, Department of Respiratory Sciences and NIHR Leicester Biomedical Research Centre (Respiratory Theme), Leicester, UK. E-mail: eag15@ 123456leicester.ac.uk
                Author information
                https://orcid.org/0000-0002-1420-8959
                Article
                00119-2020
                10.1183/23120541.00119-2020
                7680907
                33263021
                74546148-6e36-4f09-8193-b40f8b0719ec
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 06 March 2020
                : 17 July 2020
                Funding
                Funded by: Midlands Asthma and Allergy Research Association (MAARA)
                Funded by: British Lung Foundation, open-funder-registry 10.13039/501100000351;
                Funded by: Engineering and Physical Sciences Research Council, open-funder-registry 10.13039/501100000266;
                Award ID: MRC and EPSRC Stratified Medicine Grant for Molecu
                Funded by: Medical Research Council, open-funder-registry 10.13039/501100000265;
                Award ID: MRC and EPSRC Stratified Medicine Grant for Molecu
                Categories
                Original Articles
                Breath Sampling

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