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Original Research: ASTHMA |

Diagnostic Performance of an Electronic Nose, Fractional Exhaled Nitric Oxide, and Lung Function Testing in Asthma

Paolo Montuschi, MD; Marco Santonico, PhD; Chiara Mondino, MD; Giorgio Pennazza, PhD; Giulia Mantini, BEng; Eugenio Martinelli, PhD; Rosamaria Capuano, BEng; Giovanni Ciabattoni, MD; Roberto Paolesse, PhD; Corrado Di Natale, PhD; Peter J. Barnes, DM, FCCP; Arnaldo D’Amico, PhD
Author and Funding Information

From the Department of Pharmacology (Dr Montuschi), Faculty of Medicine, Catholic University of the Sacred Heart; the Department of Electronic Engineering (Drs Santonico, Martinelli, Paolesse, Di Natale, and D’Amico; and Mss Mantini and Capuano), University of Tor Vergata; Faculty of Engineering (Dr Pennazza), University Campus Bio-Medico; and the Department of Immunodermatology (Dr Mondino), Istituto Dermopatico dell’Immacolata, IDI, Rome, Italy; the Department of Drug Sciences (Dr Ciabattoni), Faculty of Pharmacy, University “G. d’Annunzio,” Chieti, Italy; and the Airway Disease Section (Dr Barnes), Imperial College, School of Medicine, National Heart and Lung Institute, London, England.

Correspondence to: Paolo Montuschi, MD, Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168 Rome, Italy; e-mail: pmontuschi@rm.unicatt.it


Funding/Support: Supported by Merck, Sharp, and Dohme, and Catholic University of the Sacred Heart academic grant 2008-2009.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):790-796. doi:10.1378/chest.09-1836
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Background:  Analysis of exhaled breath by biosensors discriminates between patients with asthma and healthy subjects. An electronic nose consists of a chemical sensor array for the detection of volatile organic compounds (VOCs) and an algorithm for pattern recognition. We compared the diagnostic performance of a prototype of an electronic nose with lung function tests and fractional exhaled nitric oxide (FENO) in patients with atopic asthma.

Methods:  A cross-sectional study was undertaken in 27 patients with intermittent and persistent mild asthma and in 24 healthy subjects. Two procedures for collecting exhaled breath were followed to study the differences between total and alveolar air. Seven patients with asthma and seven healthy subjects participated in a study with mass spectrometry (MS) fingerprinting as an independent technique for assessing between group discrimination. Classification was based on principal component analysis and a feed-forward neural network.

Results:  The best results were obtained when the electronic nose analysis was performed on alveolar air. Diagnostic performance for electronic nose, FENO, and lung function testing was 87.5%, 79.2%, and 70.8%, respectively. The combination of electronic nose and FENO had the highest diagnostic performance for asthma (95.8%). MS fingerprints of VOCs could discriminate between patients with asthma and healthy subjects.

Conclusions:  The electronic nose has a high diagnostic performance that can be increased when combined with FENO. Large studies are now required to definitively establish the diagnostic performance of the electronic nose. Whether this integrated noninvasive approach will translate into an early diagnosis of asthma has to be clarified.

Trial registration:  EUDRACT https://eudralink.emea.europa.eu; Identifier: 2007-000890-51; and clinicaltrials.gov; Identifier: NCT00819676.

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