Abstract
There is an increasing interest in the potential of exhaled biomarkers, such as volatile organic compounds (VOCs), to improve accurate diagnoses and management decisions in pulmonary diseases. The objective of this manuscript is to systematically review the current knowledge on exhaled VOCs with respect to their potential clinical use in asthma, lung cancer, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and respiratory tract infections. A systematic literature search was performed in PubMed, EMBASE, Cochrane database, and reference lists of retrieved studies. Controlled, clinical, English-language studies exploring the diagnostic and monitoring value of VOCs in asthma, COPD, CF, lung cancer and respiratory tract infections were included. Data on study design, setting, participant characteristics, VOCs techniques, and outcome measures were extracted. Seventy-three studies were included, counting in total 3,952 patients and 2,973 healthy controls. The collection and analysis of exhaled VOCs is non-invasive and could be easily applied in the broad range of patients, including subjects with severe disease and children. Various research groups demonstrated that VOCs profiles could accurately distinguish patients with a pulmonary disease from healthy controls. Pulmonary diseases seem to be characterized by a disease specific breath-print, as distinct profiles were found in patients with dissimilar diseases. The heterogeneity of studies challenged the inter-laboratory comparability. In conclusion, profiles of VOCs are potentially able to accurately diagnose various pulmonary diseases. Despite these promising findings, multiple challenges such as further standardization and validation of the diverse techniques need to be mastered before VOCs can be applied into clinical practice.
Highlights
Pulmonary diseases are important causes of morbidity in both adults and children [1,2]
Fens et al demonstrated that volatile organic compounds (VOCs) profiles were associated with both cell counts and sputum markers of inflammatory cell activation in chronic obstructive pulmonary disease (COPD) patients [83]. These findings indicate that VOCs profiles might monitor both type and activity of airway inflammation
Due to the complex pathophysiology of most pulmonary diseases, current research mainly focused on profiles of VOCs rather than on individual compounds
Summary
Background and aim Pulmonary diseases are important causes of morbidity in both adults and children [1,2]. The origin of exhaled volatile organic compounds Asthma, COPD, Cystic Fibrosis (CF), and lung cancer are characterized by inflammation and oxidative stress. Other VOCs can be identified, including nitrogen, oxygen or sulphur containing compounds These VOCs can be formed by bacteria or during (patho)physiological processes in the liver, kidneys, and pancreas [5,6]. Since exhaled VOCs are formed during inflammatory processes, the analysis of VOCs may be a promising non-invasive technique to directly monitor inflammation and oxidative stress in the airways. This information might be of help in the diagnosis and monitoring of pulmonary diseases
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