1. Post-treatment analysis Correspondence: s.scarlata@unicampus.it
Effects of topical therapy on the breath pattern of patients with newly diagnosed COPD: an e-nose based study
Scarlata Simone1; Santangelo Simona1; Pennazza Giorgio2; Santonico Marco2; Vernile Chiara2; Giannunzio Gilda1; Pedone Claudio1; Antonelli Incalzi Raffaele1.
1Chair of Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Rome – Italy
2Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio Medico University, Rome - Italy.
Aim: in COPD, pulmonary and systemic inflammation, hypoxemia and cellular oxidative stress contribute to shape the pattern of exhaled volatile compounds (VOCs).
One of the technologies to assess this pattern, known as electronic nose (e-nose), has been proved to identify breath patterns of COPD patients and to differentiate them from healthy controls. It is unknown whether an e-nose can detect changes in VOCs determined by inhaled therapy.
We aimed at verifying the presence of differences in the breath fingerprint of newly diagnosed COPD patients and to determine whether the breath print of untreated COPD patients obtained by an e-nose differed after a 12 weeks treatment with a inhaled bronchodilators or a combination of bronchodilator and steroid.
Materials and Methods : thirty-three recently diagnosed and untreated COPD patients underwent a multidimensional assessment and e-nose based breath print analysis.
The gas sensors array (based on 6 Quartz Microbalances covered with different metalloporphyrins) used for this study was fabricated by Tor Vergata University, Rome. Exhaled breath collection was achieved by using a sampling device designed, realized and patented by the authors at the Campus Biomedico University Unit for Sensor Systems.
Breath of COPD patients was collected at baseline and after a 12 week therapeutic trial with variously combined LAMA, LABA and ICS, according to current GOLD guidelines.
Differences in the COPD population breathprints were searched both at baseline and after treatment, and prediction models were created:
Baseline analysis
Bronchodilators responders vs not (↑ FEV1 >12% )
Exacerbators vs not (1 or more exacerbations in the previous 12 months)
Hyperinflated vs not (RV >120% of predicted)
Physically Impaired vs not (6mwd < 400 meters)
Emphysema vs Chronic Bronchitis (at the chest X rays examination)
Post-treatment analysis
Response to therapy (∆ FEV1 >12% of baseline)
Air trapping reduction (∆ RV > -20%)
Improved gas exchange (PaO2 ↑ > 10 mmHg)
Breath print according to the inhaled regimen: ICS + bronchodilator vs Bronchodilator alone
Results
Exacerbations
Yes No 7 3 1 14
Bronchitis
Emphisema 11 1 2 8
>12%
<12% 6 1 23
>-20%
<-20% 17 2 5 8
>-10%
<-10% 19 7
ICS +
Lama and/or Laba
Lama and/or laba
ICS+lama and/or laba 9 2 7 14
Conclusions
Changes of breath composition induced by topic medications in COPD was fairly detected by the e nose. This finding is consistent with different inhaled medications having different effects on breathprint composition of COPD patients and, then, supports the potential role of exhaled breath analysis for assessing compliance to treatment and monitoring the effect of medications in COPD.
Correspondence: