Nasal Breath Research Articles

Volatile compounds in blood headspace and nasal breath

Breath analysis is a form of metabolomics that utilises the identification and quantification of volatile chemicals to provide information about physiological or pathological processes occurring within the body. An inherent assumption of such analyses is that the concentration of the exhaled gases correlates with the concentration of the same gas in the tissue of interest. In this study we have investigated this assumption by quantifying some volatile compounds in peripheral venous blood headspace, and in nasal breath collected in Tedlar bags obtained at the same time from 30 healthy volunteers, prior to analysis by selected ion flow tube mass spectrometry. Some endogenous compounds were significantly correlated between blood headspace and nasal breath, such as isoprene (rp = 0.63) and acetone (rp = 0.68), however many, such as propanol (rp = −0.26) and methanol (rp = 0.23), were not. Furthermore, the relative concentrations of volatiles in blood and breath varied markedly between compounds, with some, such as isoprene and acetone, having similar concentrations in each, while others, such as acetic acid, ammonia and methanol, being significantly more abundant in breath, and others, such as methanal, being detectable only in breath. We also observed that breath propanol and acetic acid concentrations were higher in male compared to female participants, and that the blood headspace methanol concentration was negatively correlated to body mass index. No relationship between volatile concentrations and age was observed. Our data suggest that breath concentrations of volatiles do not necessarily give information about the same compound in the blood stream. This is likely due to the upper airway contributing compounds over and above that originating in the circulation. An investigation of the relationship between breath volatile concentrations and that in the tissue(s) of interest should therefore become a routine part of the development process of breath-based biomarkers.

Analysis of the incidence and relevant factors of retinopathy of prematurity among 109 pairs of twin premature infants

Objective To explore the incidence and related factors of retinopathy of prematurity (ROP) in twins. Methods The incidence and related factors of 109 pairs of twin premature infants were analyzed retrospectively in 218 cases of premature retinopathy screening in the Maternal and Child Health Hospital of Jiaxing during January 2012 to February 2014 Sex, birth weight, nasal oxygen breath, continuous positive airway pressure (CPAP), mechanical ventilation, blood transfusion, and others concominant disease such as asphyxia, sepsis, respiratory distress, congenital heart disease, and hypoglycemia were recorded. Two-sample t test and Logistic regression analysis were used to investigate the risk factors of ROP. Results The incidence of ROP in twin premature infants was 10.56%. There was no significant difference (P>0.05) of the incidence of ROP between lighter and heavier groups. When compared ROP group to normal fundus of premature babies in gestational age, birth weight, and Apgar score, postnatal pulmonary surfactant application, nasal oxygen breath, CPAP, mechanical ventilation, blood transfusion, anemia, asphyxia, respiratory distress, hypoalbuminemia, septicemia hypoglycemia, pulmonary hyaline membrane disease, congenital heart defects, there were statistical differences (P<0.05). Logistic regression analysis indicated that low gestational age, asphyxia, septicemia and hypoglycaemia were the possible risk factors of ROP. Conclusions The weight of twin premature infants is not a major risk factor for ROP. Gestational age, asphyxia, septicemia, and hypoglycaemia are the most important risk factors in the development of ROP. Key words: Twins; Retinopathy of prematurity; Incidence

Increased IL-6 and IL-4 in exhaled breath condensate of patients with nasal polyposis

Nasal polyposis (NP) occurs in about 1-4% of the worldwide population. Increased plasma concentrations of different pro-inflammatory cytokines have been observed in NP, and might be related to the pathogenesis of this syndrome. The present study was designed to investigate IL-6 and IL-4 concentrations in nasal and oral exhaled breath condensate of patients with early and advanced NP, and following polypectomy. Ten individuals with polyposis in early status, twenty-three patients affected by advanced status of NP and ten healthy controls were enrolled into the study. Exhaled breath condensate was collected by all individuals, according to a previous standardised method. An immunoassay kit was used to measure IL-6 and IL-4 levels. Concentrations of oral and nasal exhaled IL-6 and IL-4 were significantly higher in patients with early nasal polyposis and advanced nasal polyposis, compared to healthy controls. A statistically significant decrease of nasally but not of orally exhaled IL-6 (p < 0.001) and IL-4 (p < 0.05) was observed after polypectomy. We consider oral and nasal exhaled condensate of IL-6 and IL-4 as valid inflammatory and oxidative stress marker in patients with nasal polyposis.

Estimation of Respiratory Rates Using the Built-in Microphone of a Smartphone or Headset.

This paper proposes accurate respiratory rate estimation using nasal breath sound recordings from a smartphone. Specifically, the proposed method detects nasal airflow using a built-in smartphone microphone or a headset microphone placed underneath the nose. In addition, we also examined if tracheal breath sounds recorded by the built-in microphone of a smartphone placed on the paralaryngeal space can also be used to estimate different respiratory rates ranging from as low as 6 breaths/min to as high as 90 breaths/min. The true breathing rates were measured using inductance plethysmography bands placed around the chest and the abdomen of the subject. Inspiration and expiration were detected by averaging the power of nasal breath sounds. We investigated the suitability of using the smartphone-acquired breath sounds for respiratory rate estimation using two different spectral analyses of the sound envelope signals: The Welch periodogram and the autoregressive spectrum. To evaluate the performance of the proposed methods, data were collected from ten healthy subjects. For the breathing range studied (6-90 breaths/min), experimental results showed that our approach achieves an excellent performance accuracy for the nasal sound as the median errors were less than 1% for all breathing ranges. The tracheal sound, however, resulted in poor estimates of the respiratory rates using either spectral method. For both nasal and tracheal sounds, significant estimation outliers resulted for high breathing rates when subjects had nasal congestion, which often resulted in the doubling of the respiratory rates. Finally, we show that respiratory rates from the nasal sound can be accurately estimated even if a smartphone's microphone is as far as 30cm away from the nose.

Analysis of Short and Long Term Variability of Nasal Mucus versus Breath Condensate Inflammation Markers in Healthy Individuals

Objective: Inflammation markers were measured in nasal mucus and exhaled breath condensate (EBC) to assess the normal variability of these markers among healthy individuals. The measurement of protein markers in those matrices is valuable to provide information on inflammation endotypes and local reaction of the immune system. Methods: Inflammation markers (IFN-γ, IL-1β, IL-8, IL-10, IL-13 and TNF-α) in nasal mucus and EBC from six healthy adults were measured by Meso Scale Discovery technology. Nasal mucus was collected with sponges of polyurethane foam, which is a recently developed sampling technique. EBC was sampled via an optimized breath manoeuver with the RTUBETM device. Both collections were done within a limited sampling time of two minutes. The samples were taken on the same day and within a time period of twenty days for the determination of short and long term variability, respectively. Results: All inflammation markers were detectable in nasal mucus. This was in contrast with the measurements in EBC, in which only IFN-γ, IL-8 and IL-13 were detectable in the majority of the samples. EBC collected with the applied breathing technique gave a repeatable almost constant volume (448 μL (95% CI: 429 to 467 μL)). The collected volume of nasal mucus was more variable (from 0 to 200 μL). The variability of nasal analytes was similar over the short and long time period. The nasal inflammation marker levels were more stable within an individual than between different individuals (0.72 ≤ ICC ≤ 0.96). This was in contrast with the measurements in EBC that were highly variable over time (0.08 ≤ ICC ≤ 0.51). Conclusion: We indicate – given the good detectability and low variability of the inflammation markers determined in nasal mucus – that nasal mucus, more than EBC, is potentially a good matrix to assess inflammation in the respiratory system.

Sucking and swallowing

The absence of a bilabial contact forbids any possibility of realizing a negative pressure inside the oral cavity. It implies that the patient cannot resort to the suction gulp when he swallows his saliva. The molar occlusion will allow the lingual dome to play its role of functional matrix and to establish a nasal breath. Froggy Mouth® is a small removable appliance particularly adapted to the young patients. It is carried 15 minutes a day in front of the television, without damaging the sleep quality.It allows the stimulation of the neural circuits which manage the automatic movements and not the voluntary movements.

Hydrogen sulphide in human nasal air quantified using thermal desorption and selected ion flow tube mass spectrometry

The discovery that hydrogen sulphide (H2S) acts as a gasotransmitter when present at very low concentrations (sub-parts per billion (ppbv)) has resulted in the need to quickly quantify trace amounts of the gas in complex biological samples. Selected ion flow tube mass spectrometry (SIFT-MS) is capable of real-time quantification of H2S but many SIFT-MS instruments lack sufficient sensitivity for this application. In this study we investigate the utility of combining thermal desorption with SIFT-MS for quantifying H2S in the 0.1–1 ppbv concentration range. Human orally or nasally derived breath, and background ambient air, were collected in sampling bags and dried by passing through CaCl2 and H2S pre-concentrated using a sorbent trap optimised for the capture of this gas. The absorbed H2S was then thermally desorbed and quantified by SIFT-MS. H2S concentrations in ambient air, nasal breath and oral breath collected from 10 healthy volunteers were 0.12 ± 0.02 (mean ± SD), 0.40 ± 0.11 and 3.1 ± 2.5 ppbv respectively, and in the oral cavity H2S, quantified by SIFT-MS without pre-concentration, was present at 13.5 ± 8.6 ppbv. The oral cavity H2S correlates well with oral breath H2S but not with nasal breath H2S, suggesting that oral breath H2S derives mainly from the oral cavity but nasal breath is likely pulmonary in origin. The successful quantification of such low concentrations of H2S in nasal air using a rapid analytical procedure paves the way for the straightforward analysis of H2S in breath and may assist in elucidating the role that H2S plays in biological systems.

Exhaled nitric oxide and nasal tryptase are associated with wheeze, rhinitis and nasal allergy in primary school children

Rhinitis and asthma are the most common respiratory diseases in children. We assessed whether airway inflammation markers were associated with nasal allergies and self-reported symptoms of wheeze and rhinitis in 130 children 6–12 year old in an epidemiological context. Independent of sex and age, the fraction of exhaled nitric oxide (FeNO) and nasal mast cell (MC) activation (tryptase ≥ 5 ng/mL) were positively associated with wheeze, rhinitis and with nasal allergy. Nasal eosinophil cationic protein (ECP) and exhaled breath condensate (EBC) markers (pH, 8-isoprostane, interleukin-1β) were not associated with symptoms or with nasal allergy. In conclusion, FeNO and nasal tryptase reflect allergic inflammation in the respiratory system.

Nasal Breath in the Lateral Position for Sleep Apnea: a Retrospective Case Series

Objectives: This was a retrospective case series about the clinical effect of integrated approach with behavior therapy for obstructive sleep apnea (OSA). Methods: Medical records of twelve with OSA who were treated with behavior modification including nasal breathing with oral appliances and sleep in lateral position, oral administration of herbal medicines and acupuncture treatment between January and September of 2013 were reviewed. Apnea-hypopnea index (AHI), day time sleepiness, apneas and hypopneas counts during sleep, risk indicator (RI), oxygen desaturation index, average saturation during sleep, lowest desaturation, lowest saturation, snoring events ratio and number of desaturations (%) were assessed before and after treatments with the ApneaLink device, which is a portable diagnostic apparatus for monitoring airflows of the patients breath at home. Results: After an average 62.67 (SD 37.16) days of treatment, AHI (from 17.67, 12.79 to 8.75, 8.25, p=0.007), RI (from 22.00, 13.26 to 12.09, 8.03, p=0.004), oxygen desaturation index (from 17.33, 12.17 to 8.17, 7.86, p=0.005), and number of desaturations (from 7.00 times, 9.79 to 0.92 times, 1.39, p=0.044) showed significant improvement. Daytime sleepiness improved from 6.5 (3.2) to 3.8 (1.8) but there was no significant difference after treatment (p=0.17). No adverse events related to treatment were observed during participation in the treatment. Conclusion: From this case series, we found that behavior modification with herbal medication and acupuncture may be effective for improving sleep apnea without serious adverse events. Future randomized controlled trials with larger sample size will be necessary for concrete evidence on the benefit of this integrated treatment for OSA.

Ultrafast response humidity sensor using supramolecular nanofibre and its application in monitoring breath humidity and flow

Measuring humidity in dynamic situations calls for highly sensitive fast response sensors. Here we report, a humidity sensor fabricated using solution processed supramolecular nanofibres as active resistive sensing material. The nanofibres are built via self- assembly of donor and acceptor molecules (coronene tetracarboxylate and dodecyl methyl viologen respectively) involved in charge transfer interactions. The conductivity of the nanofibre varied sensitively over a wide range of relative humidity (RH) with unprecedented fast response and recovery times. Based on UV-vis, XRD and AFM measurements, it is found that the stacking distance in the nanofibre decreases slightly while the charge transfer band intensity increases, all observations implying enhanced charge transfer interaction and hence the conductivity. It is demonstrated to be as a novel breath sensor which can monitor the respiration rate. Using two humidity sensors, a breath flow sensor was made which could simultaneously measure RH and flow rate of exhaled nasal breath. The integrated device was used for monitoring RH in the exhaled breath from volunteers undergoing exercise and alcohol induced dehydration.

Spectral Classification of Oral and Nasal Snoring Sounds Using a Support Vector Machine

Since oral breathing during sleep tends to make the upper airway more collapsible, loud snoring caused by oral breathing is found in many sleep apnea/hypopnea patients and should be detected in the earlier stage. But unfortunately we cannot know our own sleep condition or snoring. Thus, a simple method that can detect oral snoring makes it possible to become a useful technique to develop a home medical device. For such purpose, we adopt a Support Vector Machine (SVM) classifier so as to classify oral and nasal snoring sounds based on the spectral properties. Fifteen subjects are asked to simulate snoring with oral and nasal breath respectively and the sounds are recorded with a linear sound recorder. We adopted seven kernel functions (linear, polynomial, sigmoid, Gaussian, Laplacian, chisquare, and Kullback-Leibler) for SVM-based spectral classification. As a result, over 95% of snoring sounds are successfully classified under the various cross validation test.

O21-4 Analysis of nasal exhaled breath condensate in patients with allergic rhinitis

O21-4 Analysis of nasal exhaled breath condensate in patients with allergic rhinitis

Effect of Nebulized Beclomethasone on Airway Inflammation and Clinical Status of Children with Allergic Asthma and Rhinitis: A Randomized, Double-Blind, Placebo-Controlled Study

We aimed to evaluate the therapeutic effect of nebulized beclomethasone dipropionate (nBDP) on both allergic asthma and rhinitis. In a randomized, double-blind, placebo-controlled study, 40 children (mean age 10.7 ± 2.1 years) with allergic asthma and rhinitis received either nBDP (daily dose of 800 µg, administered twice daily) or placebo for 4 weeks (with a face mask), after a 2-week run-in period of clinical assessment. Nasal and oral fractional exhaled nitric oxide (FeNO) measurements together with pulmonary function tests, nasal and oral exhaled breath condensate (EBC) collection for pH and interleukin-5 (IL-5) measurements as well as nasal and bronchial symptom scores were obtained at baseline and after 4-week treatment. A significant improvement in oral FeNO, oral and nasal EBC IL-5 and nasal EBC pH was observed in the nBDP group when comparing the values with baseline, together with an improvement in symptom score of the visual analogue scale, nasal obstruction, sneezing, rhinorrhea, breathing difficulty, cough, wheezing and sleep disturbance (nBDP end treatment vs. baseline, Wilcoxon signed-rank test). nBDP was more effective than placebo (ANCOVA test) in improving [difference Δ = response after treatment at the last visit (active or placebo) – value at baseline] nasal pH, oral IL-5, oral FeNO, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity, peek expiratory flow, visual analogue scale, breathing difficulty, cough, wheezing and sleep disturbance scores. No differences were observed between the nBDP and the placebo group for symptom score of rhinitis. nBDP is a useful treatment for airway inflammation and clinical status in children with concomitant allergic asthma and rhinitis.

Oxidative stress in the airways of children with asthma and allergic rhinitis

Even though it is well known that oxidant stress plays an important role in the pathogenesis of asthma, less is known about allergic rhinitis. Moreover, it is not known whether the co-existence of the two diseases augments the level of oxidant stress within a united airway concept. To define the level of oxidative stress in children with asthma and/or allergic rhinitis in nasal and oral exhaled breath condensates (EBC) of children. Children aged 6-18 years with asthma (n = 28), allergic rhinitis (n = 17), asthma and allergic rhinitis (n = 100), and healthy controls (n = 74) were enrolled in the study. Levels of malondialdehyde (MDA) as a marker of oxidative stress and reduced glutathione (GSH) as an antioxidant were measured by High-Performance Liquid Chromatography in the EBC. Malondialdehyde levels were higher, and GSH levels were lower in all patient groups compared to healthy controls in both nasal and oral EBC samples (p < 0.01) but there were no differences among the different patient groups. Interestingly, oral MDA levels were lower in patients with asthma and allergic rhinitis [17.78 nM (11.62-23.94)] compared to patients with asthma only [25.71 nM (18.81-32.61)] (p < 0.01). Both asthma and allergic rhinitis are associated with increased oxidative stress in the airways in children. However, the co-existence of the two diseases does not augment the oxidant stress further.

Airway assessment by four-phase rhinomanometry in septal surgery

This article updates the state of the art in functional ventilation tests of the nasal airway. Multidisciplinary international cooperation has led within the last years to the development of four-phase rhinomanometry (4PR) by eradicating the errors of the 'classic' rhinomanometry. Physical experiments, mathematical models and comprehensive statistical analyses implicate that the nasal breath consists of four phases of different diagnostic importance. Presuming the motility of the nasal entrance, it is necessary to depict the elastic behavior within the rhinomanometric curve, as well as to use new parameters for the clinical evaluation of the nasal obstruction. The parameters logarithmic vertex resistance and logarithmic effective resistance are related to the sensing of the patient. Their clinical importance was proved in studies of more than 12 000 patients. The human eye is not able to estimate the degree of impairment in nasal breathing. Therefore, a functional diagnosis is mandatory to avoid unnecessary surgery and to control the results. 4PR is a substantial improvement over the currently used methods. It should be implemented in the standards of the international standardization committee for the objective assessment of the upper airway (ISOANA). Practical hints for correct measurements are given.

Breath ammonia levels in a normal human population study as determined by photoacoustic laser spectroscopy

Photoacoustic laser spectroscopy was used as a technique to measure real-time levels of ammonia in exhaled human breath in a small, locally recruited, normal healthy population (n = 30). This yielded an average level of breath ammonia of 265 ppb, ranging from 29 to 688 ppb. Although average levels were marginally higher in male volunteers, this was not statistically significant. In addition, no correlation could be found between age, body mass index, or breath carbon dioxide levels. Monitoring of the daily routine of two individuals showed a consistent decrease in oral breath ammonia concentrations by the early afternoon (post-prandial), but was followed by a gradual increase towards late afternoon. However, in a comparison of oral and nasal breath in two volunteers, nasal breath ammonia levels were found to be significantly lower than oral levels. In addition, the daily variation was only seen in oral rather than nasal measurements which may indicate that significant background levels are predominantly of oral origin and that nasal sampling is the preferred route to eradicate this background in future studies. These results provide a healthy human breath ammonia baseline upon which other studies may be compared.

Bad breath — aetiology, differential diagnosis and therapy

25% of the population have bad breath. This can be either Foetor ex ore (90%) or Halitosis (10%). Foetor is only perceptible in mouth breath and its causes lie in the oral cavity. Halitosis is detectable in oral and/or nasal breath and stems from either the nose/pharynx (local Halitosis; nasal breath only), the lung or, rarely, the stomach (systemic Halitosis; mouth- and nose breath). A respective differential diagnosis is prerequisite for causal therapy. Foetor ex ore is caused by volatile sulphur compounds produced by proteolytic microorganisms in the oral cavity, especially on the dorsum of the tongue. Prophylaxis and therapy consequently build on mechanical and chemical reduction of these bacteria. Bad breath may become a serious social handicap and shall not be turned into a taboo.

Mundgeruch - Ursachen, Differenzialdiagnose und Behandlung

25% of the population have bad breath. This can be either Foetor ex ore (90%) or Halitosis (10%). Foetor is only perceptible in mouth breath and its causes lie in the oral cavity. Halitosis is detectable in oral and/or nasal breath and stems from either the nose/pharynx (local Halitosis; nasal breath only), the lung or, rarely, the stomach (systemic Halitosis; mouth- and nose breath). A respective differential diagnosis is prerequisite for causal therapy. Foetor ex ore is caused by volatile sulphur compounds produced by proteolytic microorganisms in the oral cavity, especially on the dorsum of the tongue. Prophylaxis and therapy consequently build on mechanical and chemical reduction of these bacteria. Bad breath may become a serious social handicap and shall not be turned into a taboo.

Exhaled Inflammatory Markers in Aspirin-Induced Asthma Syndrome

Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced asthma (AIA) syndrome, evaluating possible differences between AIA and the single pathological conditions included in AIA syndrome. Twelve patients with AIA, 17 patients with mild asthma (MA), 12 patients with nasal polyposis (NP), 11 patients with mild asthma + nasal polyposis (MA + NP), and 10 healthy subjects (HSs) were enrolled. Nasal and oral exhaled IL-4 and IL-6 were measured by enzyme immunoassay kit. Higher levels of nasal and oral exhaled IL-4 and IL-6 were observed in AIA compared with MA, NP, MA + NP, and HSs. Moreover, a positive correlation was identified between nasal exhaled IL-4 and IL-6 and, respectively, the number of neutrophils and eosinophils and in nasal scraping. The concentration of eosinophilic and neutrophilic markers in upper and lower airways of subjects with AIA syndrome is higher compared with HS and subjects with MA, NP, and MA + NP.

Influence of nasal corticosteroid therapy duration on its efficiency at nasal polyposis

Efficacy of fluticasone propionate (FP) – Flixonase, GSK, in 76 patients with nasal polyposis (NP) was studied. After the first 3-month trial phase (FP 400 mcg / day), 46 patients (the 1 st group) have continued the 12-month treatment with FP 200 mcg / day, and 23 patients (the 2-nd group) have stopped the therapy with nasal steroids. Intensity of nasal symptoms using a 4-point scale, need for topical vasoconstrictors, rhinometric ventilation parameters (nasal inspiratory flow, NIF, nasal resistance, NR) and endoscopic symptoms were evaluated every 3 months. Trial results showed various shifts in clinical and functional parameters in the compared groups. The intensity of NP symptoms in the 1-st group decreased and reached the minimal level in 6 to 12 months, NIF rate reduced and NR decreased while reaching the normal values after 12 months of the FP therapy. The 2-nd patient group had a considerable worsening of the NP symptoms and in the functional parameters of the nasal breath within 3 months after FP cancellation. After 6 month follow up these indices did not differ essentially from those at the baseline condition. Thus, the early FP cancellation can cause instability of clinical effect and fast recurrence to the initial status. Long-term (for several months) therapy of NP with decrease in the FP dose in 3 months not only can keep the achieved results, but also allows to improve them considerably.