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Evolution of clinical and environmental health applications of exhaled breath research: Review of methods and instrumentation for gas-phase, condensate, and aerosols
Wallace, A. AND J. Pleil. Evolution of clinical and environmental health applications of exhaled breath research: Review of methods and instrumentation for gas-phase, condensate, and aerosols. ANALYTICA CHIMICA ACTA. Elsevier Science Ltd, New York, NY, 1024:18-36, (2018).
Before the advent of even the simplest laboratory instrumentation, the human nose served as the original chemical detector for disease diagnosis. It all started with Hippocrates (born 460 BC) who taught his students to use breath odor to identify patients with liver disease, uncontrolled diabetes, and failing kidneys.1 There are a few additional pivotal moments in breath history that bring us to the present. In 1971, Linus Pauling published a seminal article demonstrating analytical methodology used to identify approximately 250 compounds in breath in addition to nitrogen, oxygen, water and carbon dioxide.2 The final step in ushering in the modern era of 47 breath research came from the work of Lance Wallace of the U.S. Environmental Protection 48 Agency, who recognized that breath analysis could unambiguously document recent exposures to environmental contaminants.3 Michael Phillips (St. Vincent’s Medical Center, New York and Mensanna Research Inc., New Jersey) also contributed by developing case-control studies starting in 1987 using breath constituents and patterns to discern a variety of adverse health states including lung and breast cancer as well as cardio-pulmonary disease.4-5
Human breath, along with urine and blood, has long been one of the three major biological media for assessing human health and environmental exposure. In fact, the detection of odor on human breath, as described by Hippocrates in 400 BC, is considered the first analytical health assessment tool. Although less common in comparison to contemporary bio-fluids analyses, breath is again becoming an attractive diagnostic medium as sampling is non-invasive, unlimited in timing and volume, and does not require clinical personnel. The goal of this article is to document the permeation of breath-related research within the broader context of human health research through the frequency of peer-reviewed articles in relevant topic areas. Herein, publications for specific topics are tracked through time and evaluated with respect to past and future trends in breath research. The evolution of breath research is documented graphically, and representative articles are selected to illustrate the shifting importance of breath-related research. In addition to traditional research for exposure assessment and disease diagnosis, emerging topics such as exhaled breath condensate (EBC), exhaled breath aerosols (EBA), cellular level respiration, cytokine analyses, crowd breath collection, use of canine olfaction, and advances in analytical technologies are included in the evaluations.