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Exhaled breath analysis by use of eNose technology: a novel diagnostic tool for interstitial lung disease

Catharina C. Moor, Judith C. Oppenheimer, Gizal Nakshbandi, Joachim G.J.V. Aerts, Paul Brinkman, Anke-Hilse Maitland-van der Zee, Marlies S. Wijsenbeek
European Respiratory Journal 2021 57: 2002042; DOI: 10.1183/13993003.02042-2020
Catharina C. Moor
1Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
3These authors share first authorship
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Judith C. Oppenheimer
1Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
3These authors share first authorship
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Gizal Nakshbandi
1Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Joachim G.J.V. Aerts
1Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Paul Brinkman
2Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Rotterdam, The Netherlands
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Anke-Hilse Maitland-van der Zee
2Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Rotterdam, The Netherlands
4These authors share senior authorship
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Marlies S. Wijsenbeek
1Center of Excellence and European Reference Center for Interstitial Lung Disease and Sarcoidosis, Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract

Introduction Early and accurate diagnosis of interstitial lung diseases (ILDs) remains a major challenge. Better noninvasive diagnostic tools are much needed. We aimed to assess the accuracy of exhaled breath analysis using eNose technology to discriminate between ILD patients and healthy controls, and to distinguish ILD subgroups.

Methods In this cross-sectional study, exhaled breath of consecutive ILD patients and healthy controls was analysed using eNose technology (SpiroNose). Statistical analyses were done using partial least square discriminant analysis and receiver operating characteristic analysis. Independent training and validation sets (2:1) were used in larger subgroups.

Results A total of 322 ILD patients and 48 healthy controls were included: sarcoidosis (n=141), idiopathic pulmonary fibrosis (IPF) (n=85), connective tissue disease-associated ILD (n=33), chronic hypersensitivity pneumonitis (n=25), idiopathic nonspecific interstitial pneumonia (n=10), interstitial pneumonia with autoimmune features (n=11) and other ILDs (n=17). eNose sensors discriminated between ILD and healthy controls, with an area under the curve (AUC) of 1.00 in the training and validation sets. Comparison of patients with IPF and patients with other ILDs yielded an AUC of 0.91 (95% CI 0.85–0.96) in the training set and an AUC of 0.87 (95% CI 0.77–0.96) in the validation set. The eNose reliably distinguished between individual diseases, with AUC values ranging from 0.85 to 0.99.

Conclusions eNose technology can completely distinguish ILD patients from healthy controls and can accurately discriminate between different ILD subgroups. Hence, exhaled breath analysis using eNose technology could be a novel biomarker in ILD, enabling timely diagnosis in the future.

Abstract

Exhaled breath analysis using eNose technology can accurately discriminate between different ILD subgroups and individual diseases. eNose technology could be a novel diagnostic tool in ILD, enabling timely diagnosis in the future. https://bit.ly/3jJs2hf

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • This study is registered at the Netherlands Trial Register with identifier NL7860.

  • Conflict of interest: C.C. Moor reports grants from Boehringer Ingelheim, during the conduct of the study; grants and other from Boehringer Ingelheim, outside the submitted work; all fees and grants were paid to the Erasmus MC.

  • Conflict of interest: J.C. Oppenheimer has nothing to disclose.

  • Conflict of interest: G. Nakshbandi has nothing to disclose.

  • Conflict of interest: J.G.J.V. Aerts has nothing to disclose.

  • Conflict of interest: P. Brinkman has nothing to disclose.

  • Conflict of interest: A-H. Maitland-van der Zee reports grants from GSK, grants and personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, outside the submitted work; all personal fees were paid to the Amsterdam UMC.

  • Conflict of interest: M.S. Wijsenbeek reports grants from Boehringer Ingelheim, during the conduct of the study; grants and other from Boehringer Ingelheim and Hoffman la Roche, other from Galapagos and Respivant, outside the submitted work; all fees and grants were paid to the Erasmus MC.

  • Support statement: The lease for the SpiroNose was financially supported by Boehringer Ingelheim. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received May 28, 2020.
  • Accepted July 20, 2020.
  • Copyright ©ERS 2021
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Exhaled breath analysis by use of eNose technology: a novel diagnostic tool for interstitial lung disease
Catharina C. Moor, Judith C. Oppenheimer, Gizal Nakshbandi, Joachim G.J.V. Aerts, Paul Brinkman, Anke-Hilse Maitland-van der Zee, Marlies S. Wijsenbeek
European Respiratory Journal Jan 2021, 57 (1) 2002042; DOI: 10.1183/13993003.02042-2020

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Exhaled breath analysis by use of eNose technology: a novel diagnostic tool for interstitial lung disease
Catharina C. Moor, Judith C. Oppenheimer, Gizal Nakshbandi, Joachim G.J.V. Aerts, Paul Brinkman, Anke-Hilse Maitland-van der Zee, Marlies S. Wijsenbeek
European Respiratory Journal Jan 2021, 57 (1) 2002042; DOI: 10.1183/13993003.02042-2020
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