Volatile organic compounds associated with diagnosis and disease characteristics in asthma – A systematic review

• Published in: Respiratory medicine 2020-08, Vol.169, p.105984-105984, Article 105984
• Main Authors: Peel, Adam M., Wilkinson, Maxim, Sinha, Ashnish, Loke, Yoon K., Fowler, Stephen J., Wilson, Andrew M.
• Format: Article
• Language: English
• Subjects: Accuracy; Asthma; Asthma - diagnosis; Asthma - metabolism; Bias; Biomarkers; Biomarkers - analysis; Breath Tests - methods; Diagnosis; Diagnostic tests; Disease control; Female; Humans; Identification methods; Male; Medical diagnosis; Metabolites; Metabolomics; Molecular weight; Organic compounds; Phenotyping; Precision medicine; Principal components analysis; Quality; Quality assessment; Severity of Illness Index; Statistical analysis; Statistical methods; Systematic review; VOCs; Volatile organic compounds; Volatile Organic Compounds - analysis
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2020.105984

Metabolomics refers to study of the metabolome, the entire set of metabolites produced by a biological system. The application of metabolomics to exhaled breath samples - breathomics - is a rapidly growing field with potential application to asthma diagnosis and management. We aimed to review the adult asthma breathomic literature and present a comprehensive list of volatile organic compounds identified by asthma breathomic models. We undertook a systematic search for literature on exhaled volatile organic compounds in adult asthma. We assessed the quality of studies and performed a qualitative synthesis. We identified twenty studies; these were methodologically heterogenous with a variable risk of bias. Studies almost universally reported breathomics to be capable of differentiating - with moderate or greater accuracy - between samples from healthy controls and those with asthma; and to be capable of phenotyping disease. However, there was little concordance in the compounds upon which discriminatory models were based. Results to-date are promising but validation in independent prospective cohorts is needed. This may be challenging given the high levels of inter-individual variation. However, large-scale, multi-centre studies are underway and validation efforts have been aided by the publication of technical standards likely to increase inter-study comparability. Successful validation of breathomic models for diagnosis and phenotyping would constitute an important step towards personalised medicine in asthma. •The majority of published studies report breathomics capable of differentiating between samples from healthy controls, those with asthma, and those with other respiratory disease.•Of the seventy six volatile organic compounds cited as significant in the literature, nine were reported in more than one paper.•Validation ofthese findings in independent prospective cohorts is the next step in developing disease biomarkers.