Breath analysis by
secondary electrospray ionization-high resolution
mass spectrometry (SESI-HRMS) offers the possibility to measure comprehensive
metabolic profiles. The technology is currently being deployed in
several clinical settings in Switzerland and China. However, patients
are required to exhale directly into the device located in a dedicated
room. Consequently, clinical implementation in patients incapable
of performing necessary exhalation maneuvers (e.g., infants) or immobile
(e.g., too weak, elderly, or in intensive care) remains a challenge.
The aim of this study was to develop a method to extend such breath
analysis capabilities to this subpopulation of patients by collecting
breath samples remotely (offline) and promptly (within 10 min) transfer
them to SESI-HRMS for chemical analysis. We initially assessed the
method in adults by comparing breath mass spectra collected offline
with Nalophan bags against spectra of breath samples collected in
real time. In total, 13 adults provided 176 pairs of real-time and
offline measurements. Lin’s concordance correlation coefficient
(CCC) was used to estimate the agreement between offline and real-time
analyses. Here, 1249 mass spectral features (55% of total detected)
exhibited Lin’s CCC > 0.6. Subsequently, the method was
successfully
deployed to analyze breath samples from infants (n = 16), obtaining as a result SESI-HRMS breath profiles. To demonstrate
the clinical feasibility of the method, we measured in parallel other
clinical variables: (i) lung function, which characterizes the breathing
patterns, and (ii) nitric oxide, which is a surrogate marker of airway
inflammation. As a showcase, we focused our analysis on the exhaled
oxidative stress marker 4-hydroxynonenal and its association with
nitric oxide and minute ventilation.