Use of exhaled breath condensate to investigate occupational lung diseases

Our plain-English summary of Use of exhaled breath condensate to investigate occupational lung diseases, by M. Corradi, P. Gergelova, A. Mutti (Current Opinion in Allergy and Clinical Immunology, 2010).

The study

• Authors: M. Corradi, P. Gergelova, A. Mutti
• Journal: Current Opinion in Allergy and Clinical Immunology
• Published: 2010;10(2):93-8
• Type of article: Review
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose Of Review: The present study reviews recent data concerning the assessment of exhaled breath condensate (EBC) pulmonary biomarkers in the field of occupational medicine.

Recent Findings: EBC is a suitable matrix to assess respiratory health status in workers exposed to pneumotoxic substances, due to its ability to quantify lung tissue dose and consequent pulmonary effects. Published data show that toxic metals and trace elements are detectable in EBC, raising the possibility of using this medium to quantify the lung tissue dose of metals occurring in occupational settings. EBC analysis of biomarkers of exposure highlighted the potential use of EBC as completion of the biological monitoring of pneumotoxic compounds. Different biomarkers of effect, such as oxidative stress and inflammatory-derived biomarkers have been applied in the investigation of occupational asthma and pneumoconiosis, suggesting that the collection of EBC may contribute to studying the pathological state of the airways of workers with acute and chronic exposure to pollutants. EBC measurements also seem to be reliable to detect the presence of carcinogenic processes in the respiratory system, by the analysis of various markers of oxidative stress, angiogenesis and DNA alterations related to lung cancer. This approach may open new frontiers in the study of workers currently or previously exposed to pulmonary carcinogenic agents.

Summary: The analysis of EBC is one of the most promising methods currently available for the study of pulmonary biomarkers of exposure, effect and susceptibility in occupational settings; being collected in a totally noninvasive way, it is particularly suitable to be applied in field studies and for longitudinal assessments of pulmonary biology.

In plain English

This article was a review, not a new study. The authors reviewed recent research on exhaled breath condensate (EBC): moisture collected by cooling a person's breath, which can be tested for substances and signs of lung damage without invasive procedures. The studies reviewed looked at workers exposed to metals such as cobalt, tungsten and chromium, at grain workers, welders and asbestos-exposed workers, and at patients with silicosis. Other studies covered nine healthy people briefly exposed to toluene, people with asthmatic reactions to isocyanates, and patients with lung cancer. On asbestos, the review reported that one study (Pelclova and colleagues) found significantly higher levels of 8-isoprostane, a marker of oxidative stress, in asbestos-exposed people than in controls. It also reported that patients with asbestosis had raised EBC levels of 8-isoprostane, hydrogen peroxide and total protein. A third study found differences between controls and patients with asbestosis, pleural hyalinosis and silicosis. The authors concluded that many biomarkers can be detected in EBC. They added that the method still has substantial limitations that prevent its routine use for workplace monitoring, and that standardization and reference values are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of recent published studies on exhaled breath condensate biomarkers in occupational medicine
• Who was studied: Published studies (no new participants) of workers exposed to lung-damaging substances, healthy volunteers given a brief toluene exposure, people with isocyanate-induced asthmatic reactions, patients with asbestos- or silica-related diseases, asthma or COPD, and patients with lung cancer
• Exposure: Toxic metals (cobalt, tungsten, hexavalent chromium, among others) in workers; grain work, welding fumes and asbestos in workers; silica; isocyanates in specific inhalation challenges; and a brief 20-minute toluene exposure in nine healthy individuals. Asbestos fiber types were not specified
• Main results:
  • A reviewed study by Pelclova and colleagues found significantly higher EBC 8-isoprostane levels in asbestos-exposed individuals than in a control group
  • The review reported that patients with asbestosis had increased EBC levels of 8-isoprostane, hydrogen peroxide and total protein. No significant changes were found in exhaled carbon monoxide, EBC total nitrogen oxides or 3-nitrotyrosine (reference 23, Chow and colleagues)
  • A reviewed study by Syslova and colleagues found differences in all oxidative stress biomarkers in all body fluids between controls and patients with asbestosis, pleural hyalinosis and silicosis. The difference in EBC was the most statistically significant
  • In a reviewed study by Goldoni and colleagues of 33 workers exposed to cobalt and tungsten and 16 healthy controls, EBC cobalt (up to 741 nmol/l) and tungsten (up to 76.1 nmol/l) in exposed workers were higher at the end of the shift. A later study by Broding and colleagues found no correlation between EBC and urinary levels
  • In a reviewed study of 24 chrome-plating workers, about 33.5% of chromium in EBC was still in the hexavalent form immediately after chromate exposure
  • In a reviewed study by Gessner and colleagues of 74 individuals, EBC angiogenic markers were significantly higher in 17 people with newly diagnosed non-small cell lung cancer than in patients with COPD and in healthy volunteers
• The authors' conclusion: The authors concluded that numerous biomarkers are detectable in EBC and that it can be used in clinical and occupational settings. They also concluded that substantial limitations currently prevent its routine use for biomonitoring at the workplace
• Limitations the authors state:
  • The authors stated that EBC collection and data reporting need standardization, and that EBC biomarkers need validation for specific uses
  • The authors stated that reference values in healthy non-exposed people (smokers and nonsmokers) still need to be established for all biomarkers
  • The authors noted that results on EBC pH in exposed workers are conflicting
  • The authors noted that nitrogen oxides are unstable, affected by other factors, and difficult to measure, making them less useful for asbestos-related diseases

Topics

Medical terms in this study, explained in our Lexicon: Occupational Lung Disease, Biomarker, Oxidative Stress, Pneumoconiosis, Carcinogenic, Angiogenesis, Lung Cancer.

Related studies

• Oxidative stress markers in exhaled breath condensate in lung fibroses are not significantly affected by systemic diseases — D. Pelclová, Z. Fenclová, et al. (2011)
• Leukotrienes B4, C4, D4 and E4 in the exhaled breath condensate (EBC), blood and urine in patients with pneumoconiosis — D. Pelclová, Z. Fenclová, et al. (2012)
• Increased 8-isoprostane, a marker of oxidative stress in exhaled breath condensate in subjects with asbestos exposure — D. Pelclová, Z. Fenclová, et al. (2008)
• Increased alveolar nitric oxide concentration and high levels of leukotriene B(4) and 8-isoprostane in exhaled breath condensate in patients with asbestosis — H. Lehtonen, P. Oksa, et al. (2007)
• A breath test for malignant mesothelioma using an electronic nose — E.A. Chapman, P.S. Thomas, et al. (2012)
• An electronic nose distinguishes exhaled breath of patients with Malignant Pleural Mesothelioma from controls — S. Dragonieri, M.P. van der Schee, et al. (2012)

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