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Translating Basic Research Into Clinical Practice |

Breathomics in Lung DiseaseBreathomics in Lung Disease

Marc Philippe van der Schee, MD; Tamara Paff, MD; Paul Brinkman, MSc; Willem Marinus Christiaan van Aalderen, MD, PhD; Eric Gerardus Haarman, MD, PhD; Peter Jan Sterk, MD, PhD
Author and Funding Information

From the Department of Respiratory Medicine (Drs van der Schee and Sterk and Mr Brinkman), the Department of Pediatric Respiratory Medicine and Allergy (Drs van der Schee and van Aalderen), Emma’s Children Hospital, Academic Medical Centre, University of Amsterdam; and the Department of Pediatric Pulmonology (Drs van der Schee, Paff, and Haarman), the Department of Pulmonary Diseases (Dr Paff), and the Department of Clinical Genetics (Dr Paff), VU University Medical Center, Amsterdam, The Netherlands.

CORRESPONDENCE TO: Marc Philippe van der Schee, MD, Department of Respiratory Medicine, F5-260, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; e-mail: m.p.vanderschee@amc.uva.nl


Drs van der Schee and Paff are both first authors, contributing equally to this manuscript.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(1):224-231. doi:10.1378/chest.14-0781
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Volatile organic compounds (VOCs) are produced by virtually all metabolic processes of the body. As such, they have potential to serve as noninvasive metabolic biomarkers. Since exhaled VOCs are either derived from the respiratory tract itself or have passed the lungs from the circulation, they are candidate biomarkers in the diagnosis and monitoring of pulmonary diseases in particular. Good examples of the possibilities of exhaled volatiles in pulmonary medicine are provided by the potential use of VOCs to discriminate between patients with lung cancer and healthy control subjects and to noninvasively diagnose infectious diseases and the association between VOCs and markers of disease activity that has been established in obstructive lung diseases. Several steps are, however, required prior to implementation of breath-based diagnostics in daily clinical practice. First, VOCs should be studied in the intention-to-diagnose population, because biomarkers are likely to be affected by multiple (comorbid) conditions. Second, breath collection and analysis procedures need to be standardized to allow pooling of data. Finally, apart from probabilistic analysis for diagnostic purposes, detailed examination of the nature of volatile biomarkers not only will improve our understanding of the pathophysiologic origins of these markers and the nature of potential confounders but also can enable the development of sensors that exhibit maximum sensitivity and specificity toward specific applications. By adhering to such an approach, exhaled biomarkers can be validated in the diagnosis, monitoring, and treatment of patients in pulmonary medicine and contribute to the development of personalized medicine.

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