New Perspectives in Monitoring Lung Inflammation: Analysis of Exhaled Breath Condensate

New Perspectives in Monitoring Lung Inflammation: Analysis of Exhaled Breath Condensate

Attracting the attention of the medical community, exhaled breath condensate is a completely non-invasive method for sampling secretions from the airways. Analysis of exhaled breath condensate is potentially useful for monitoring airway inflammation and in pharmacological therapy. With its non-invasive nature, this method may be suitable for longitudinal studies even in children and in patients with lung severe disease.

New Perspectives in Monitoring Lung Inflammation provides an introduction to the analysis of exhaled breath condensate for monitoring lung inflammation. The book presents current knowledge on the physicochemical properties of exhaled breath condensate and its formation in the airways and covers important aspects of the methodology. It details markers, and classes of markers, of airway inflammation in separate chapters and discusses the use of the technique in adults and children. The text also reviews the implications for drug development and future research. The volume concludes with an overview of lung inflammation focusing on basic and clinical pharmacology of important mediators.

Presenting a comprehensive view of exhaled breath condensate, the text explains how this method could play a major role in the diagnosis and therapy of lung diseases, and may launch a new era in respiratory medicine.

There is increasing interest in exhaled breath condensate, a noninvasive method to study airway inflammation. Exhaled breath consists of a gaseous phase containing volatile substances (e.g., nitric oxide and carbon monoxide) and a liquid phase,termed exhaled breath condensate, that contains aerosol particles in which nonvolatile substances (e.g., inflammatory mediators) have been identified. Analysis of exhaled breath condensate is potentially useful for monitoring airway inflammation and pharmacological therapy. Identification of selective profiles of inflammatory markers in exhaled breath condensate in different lung diseases might be relevant to differential diagnosis. Given its noninvasiveness, this method might be suitable for longitudinal studies in patients with lung disease, including children.
This book provides an introduction to the analysis of exhaled breath condensate. To provide an overview of lung inflammation, basic and clinical pharmacology of leukotrienes, prostanoids, cytokines, chemokines, and tachykinins in the respiratory system is presented.
Current knowledge on the physicochemical properties of exhaled breath condensate and its formation in the airways is presented, and the methods for collection of exhaled breath condensate are described. Particular emphasis is put on the methodological issues because they are essential for future development of this technique.
The number of molecules identified in exhaled breath condensate is rapidly increasing. Information on biomarkers and/or classes of biomarkers of airway inflammation that have been measured in this biological fluid are presented in single chapters. One chapter takes into consideration the potential applications of analysis of exhaled breath condensate in children. At present, the quantification of lung inflammation is mainly based on invasive or semi-invasive methods or on measurement of inflammatory biomarkers in biological fluids that are likely to reflect systemic rather than lung inflammation. Assessment of lung inflammation is relevant for diagnosis and management of inflammatory lung diseases because the inflammatory process often precedes the onset of symptoms and decrease in lung function. The availability of sensitive noninvasive biomarkers of lung inflammation might indicate the need for beginning anti-inflammatory therapy at an earlier stage and have a significant impact on the management of lung diseases including asthma and chronic obstructive pulmonary disease. Measurement of inflammatory biomarkers in exhaled breath condensate might provide more sensitive end points for clinical trials in respiratory medicine — a uniquely valuable approach to establish the effectiveness of dose regimens of current drugs and a rational basis for assessing new pharmacological therapies. The potential implications of analysis of exhaled breath condensate for diagnosis and therapy of respiratory diseases are thoroughly discussed in this book,and indications for future research in this area are provided.Standardization and validation of analysis of exhaled breath condensate currently are the main priority in this research area. At present, the lack of a standardized technique makes it difficult to compare the results from different laboratories. Robust analytical methodology usually precedes the application of a new technique. In the case of exhaled breath condensate, the initial enthusiasm, the search for new molecules in this biological fluid, and the availability of immunoassays for several inflammatory mediators led researchers to overlook a rigorous analytical approach, leaving open the question of the specificity and reliability of measurements. Because several methodological issues still need to be addressed, whether and when the analysis of exhaled breath condensate will be applicable to the clinical setting is difficult to predict. However, considering the importance of inflammation in the pathophysiology of lung disease, the relative lack of noninvasive methods for monitoring airway inflammation and therapy, and the relevance of its potential applications, further research on exhaled breath condensate analysis is warranted. Identification of breath “fingerprints” might open a new era in respiratory medicine. These are the promises. Future research will attest whether they are a reality

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